The Korean Medication Algorithm for Depressive Disorder: second revision

This study constitutes a revision of the guidelines for the treatment of major depressive disorder (MDD) issued by the Korean Medication Algorithm Project for Depressive Disorder (KMAP-DD) 2006. In incorporates changes in the experts׳ consensus that occurred between 2006 and 2012 as well as information regarding newly developed and recently published clinical trials.

Using a 44-item questionnaire, an expert consensus was obtained on pharmacological treatment strategies for (1) non-psychotic MDD, (2) psychotic MDD, (3) dysthymia and depression subtypes, (4) continuous and maintenance treatment, and (5) special populations; consensus was also obtained regarding (6) the choice of an antidepressant (AD) in the context of safety and adverse effects, and (7) non-pharmacological biological therapies.

AD monotherapy was recommended as the first-line strategy for nonpsychotic depression in adults, children and adolescents, elderly adults, and patients with postpartum depression or premenstrual dysphoric disorder. The combination of AD and atypical antipsychotics (AAP) was recommended for psychotic depression. The duration of the initial AD treatment for psychotic depression depends on the number of depressive episodes. Most experts recommended stopping the initial AD and AAP therapy after a certain period in patients with one or two depressive episodes. However, for those with three or more episodes, maintenance of the initial treatment was recommended for as long as possible. Monotherapy with various selective serotonin reuptake inhibitors (SSRIs) and serotonin and norepinephrine reuptake inhibitors (SNRIs) was recommended for dysthymic disorder and melancholic type MDD.

The pharmacological treatment strategy of KMAP-DD 2012 is similar to that of KMAP-DD 2006; however, the preference for the first-line use of AAPs was stronger in 2012 than in 2006.