한국형 우울장애 약물치료 알고리듬 2006 (Ⅳ) : 우울장애의 아형 및 부작용에 따른 항우울제의 선택과 여성우울장애에서의 치료전략
Korean Medication Algorithm for Depressive Disorder 2006 (Ⅳ) : The Choice of Antidepressant According to the Subtypes of Depression, Adverse Effects of Antidepressant and Teatment Strategies in Women
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이상 살펴 본 임상양상 및 부작용에 따른 항우울제의 선택과 여성우울장애에서의 치료 전략에 대한 이번 연구는 설문 대상 전문가 수가 제한되어 있고 근거보다는 상대적으로 임상경험에 더욱 의존하였을 가능성이 높아 한계를 가지고 있지만, KMAP-DD 2002에서는 다루지 않은 내용이었으며 외국의 지침서에서도 제한된 부분만을 다루고 있어서 국내 임상가들에게 새로운 치료적 지침을 제시하였다는 점에서 그 의의가 있다고 하겠다. 하지만 이러한 지침이 모든 임상가와 환자에게 가장 좋은 선택을 이끌어 낸다고 할 수는 없으며 계속 보완되어 가는 과정을 거치고 환자의 임상상황에 맞춰 효과적으로 적용될 때 더 유용하게 사용될 것이다.
Abstract
Objectives：In 2002, the Korean Medication Algorithm Project for Major depressive Disorder (KMAP-MD) was published, but there has been a need for a guideline about detailed issues of depressive disorder. We revised KMAP-MDD and reestablished Korean Medication Algorithm Project for Depressive Disorder (KMAP-DD) in 2006. Methods：A questionnaire had been developed by the executive committee for KMAP-DD. The review committee consisted of 101 experienced psychiatrists. From the total of 22 questions in the questionnaire, 7 questions were evaluated for these subjects . We classified the expert opinions to 3 categories according to its confidence interval; first, second and third line. Results：SSRI and venlafaxine were the first line antidepressants (AD) for atypical and melancholic depression. For dysthymic disorder and minor depressive disorder, SSRI was recommended as the first line medications. Only AD medications was a preferred initial strategy for treating premenstrual dysphoric disorder, mild to moderate and severe non-psychotic postpartum depression. In severe psychotic postpartum depression, combination therapy of AD and atypical antipsychotics was the treatment of choice. SSRI was preferred when considering sedation, anticholinergic and cardiovascular adverse effects. Also, experts recommended mirtazapine against gastrointestinal adverse effects and bupropion in avoiding sexual dysfunction. Conclusion：These results suggest that clinicians have to consider both clinical situations and drug adverse effects in the choice of antidepressant medications. (J Korean Neuropsychiatr Assoc 2007;46(6):610-616)
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