한국형 우울장애 약물치료 알고리듬 2025 (II): 임상 아형
Korean Medication Algorithm Project for Depressive Disorder 2025 (II): The Subtypes of Depression
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Objectives The Korean Medication Algorithm Project for Depressive Disorder (KMAP-DD) has been continuously revised. The sixth edition reflected new findings and the latest trends in the areas of pharmacological treatment. This study aimed to suggest strategies and treatment options according to the subtype of depression using data from the KMAP-DD-2025. Methods A total of 136 psychiatrists with clinical experience in depressive disorders were selected. The questionnaires for KMAP-DD 2025 were sent to these participants via mail. The KMAP-DD 2025 comprises overall treatment strategies and treatment options under specific circumstances. Each treatment strategy or treatment option was evaluated with an overall score of nine and was divided into three phases of recommendation. Results For persisting depressive disorder, antidepressant monotherapy including selective serotonin reuptake inhibitor (SSRI), serotonin-norepinephrine reuptake inhibitor (SNRI), bupropion, agomelatine, vortioxetine, and mirtazapine, and combination therapy of antidepressants with atypical antipsychotics were recommended as first-line medications. For melancholia of major depressive disorder, SSRI, SNRI, mirtazapine, vortioxetine, milnacipran, bupropion, and agomelatine were recommended as first-line medications. For mixed features, escitalopram, sertraline, desvenlafaxine, fluoxetine, paroxetine, bupropion, aripiprazole, quetiapine, olanzapine, valproate, lithium, and lamotrigine were recommended as first-line medications. For anxious distress, escitalopram, sertraline, paroxetine, desvenlafaxine, venlafaxine, mirtazapine, fluoxetine, duloxetine, aripiprazole, quetiapine, and olanzapine were recommended as first-line medications. Conclusion The preferences of experts regarding antidepressants, mood stabilizers, and antipsychotics differed according to the subtype of depression. These findings suggest that experts treat patients with a major depressive disorder after considering the depression subtype.
Abstract
Objectives The Korean Medication Algorithm Project for Depressive Disorder (KMAP-DD) has been continuously revised. The sixth edition reflected new findings and the latest trends in the areas of pharmacological treatment. This study aimed to suggest strategies and treatment options according to the subtype of depression using data from the KMAP-DD-2025. Methods A total of 136 psychiatrists with clinical experience in depressive disorders were selected. The questionnaires for KMAP-DD 2025 were sent to these participants via mail. The KMAP-DD 2025 comprises overall treatment strategies and treatment options under specific circumstances. Each treatment strategy or treatment option was evaluated with an overall score of nine and was divided into three phases of recommendation. Results For persisting depressive disorder, antidepressant monotherapy including selective serotonin reuptake inhibitor (SSRI), serotonin-norepinephrine reuptake inhibitor (SNRI), bupropion, agomelatine, vortioxetine, and mirtazapine, and combination therapy of antidepressants with atypical antipsychotics were recommended as first-line medications. For melancholia of major depressive disorder, SSRI, SNRI, mirtazapine, vortioxetine, milnacipran, bupropion, and agomelatine were recommended as first-line medications. For mixed features, escitalopram, sertraline, desvenlafaxine, fluoxetine, paroxetine, bupropion, aripiprazole, quetiapine, olanzapine, valproate, lithium, and lamotrigine were recommended as first-line medications. For anxious distress, escitalopram, sertraline, paroxetine, desvenlafaxine, venlafaxine, mirtazapine, fluoxetine, duloxetine, aripiprazole, quetiapine, and olanzapine were recommended as first-line medications. Conclusion The preferences of experts regarding antidepressants, mood stabilizers, and antipsychotics differed according to the subtype of depression. These findings suggest that experts treat patients with a major depressive disorder after considering the depression subtype.