본문 바로가기
KERD
논문KCI 등재

근거중심 한국형 우울증 약물학적 치료지침, 개정판(III) : 항우울제의 증량, 교체, 병합 및 강화요법

Evidence-Based Korean Pharmacological Treatment Guideline for Depression, Revised Edition (III) : Dose Increment, Switching, Combination, and Augmentation Strategy in Antidepressant Therapy

한상우|이민수|이경민|오강섭|백종우|박용천|최준호|이강준|이화영|함병주|한창수|황태연|이희영|이문수|심세훈|고영훈|박선철|구재우|전홍진|성승환|원은수|한규만
대한신경정신의학회 (Korean Neuropsychiatric Association)|2013.09|신경정신의학 (JOURNAL OF THE KOREAN NEUROPSYCHIATRIC ASSOCIATION)|제52권 제5호|pp. 386-401

1

조회

0

다운로드

2

인용

0

참고문헌

키워드

주요우울장애GuidelineMajor depressive disorder교체SwitchingCombination진료지침항우울제병합요법Antidepressant증량강화요법Augmentation.
주제분류정신과학

초록

Objectives The aim of this study was to demonstrate the recommendations for antidepressant treatment strategy of dose increment, switching, combination, and augmentation therapy derived from Evidence-Based Korean Pharmacological Treatment Guideline for Depression, Revised Edition. Methods The guideline was developed through adaptation of 12 domestic and foreign clinical guidelines for depression, with key questions concerning pharmacotherapy of depression, and drawing of recommendations. Results The guideline strongly recommended dose increment, switching, and combination and augmentation therapy of antidepressant when patients with depression showed inadequate treatment outcomes from initial antidepressant treatment. The dose increment was strongly recommended when the patients had insufficient response from treatment with tricyclic antidepressants (TCAs), monoamine oxidase inhibitors, selective serotonin reuptake inhibitors (SSRIs), and serotonin and norepinephrine reuptake inhibitors (SNRIs). Switching from SSRI to non-SSRI was also strongly recommended. The combination of initial medication and other classes of antidepressants could benefit from treatment with TCAs, SSRIs, SNRIs, and noradrenergic and specific serotonergic antidepressants. Combination with norepinephrine and dopamine reuptake inhibitors or serotonin-2 antagonist/reuptake inhibitors was weakly recommended. The guideline strongly recommended use of the augmentation strategy of adding lithium or benzodiazepine to initial antidepressants. Augmentation of lamotrigine, T3, methylphenidate, and modafinil was weakly recommended. Conclusion If the initial outcomes of antidepressant therapy are unsatisfactory to the patients the next-step strategies of dose increment, switching, combination and augmentation of antidepressants should be considered after rechecking the patients’ drug compliance, dose, and diagnosis.

Abstract

Objectives The aim of this study was to demonstrate the recommendations for antidepressant treatment strategy of dose increment, switching, combination, and augmentation therapy derived from Evidence-Based Korean Pharmacological Treatment Guideline for Depression, Revised Edition. Methods The guideline was developed through adaptation of 12 domestic and foreign clinical guidelines for depression, with key questions concerning pharmacotherapy of depression, and drawing of recommendations. Results The guideline strongly recommended dose increment, switching, and combination and augmentation therapy of antidepressant when patients with depression showed inadequate treatment outcomes from initial antidepressant treatment. The dose increment was strongly recommended when the patients had insufficient response from treatment with tricyclic antidepressants (TCAs), monoamine oxidase inhibitors, selective serotonin reuptake inhibitors (SSRIs), and serotonin and norepinephrine reuptake inhibitors (SNRIs). Switching from SSRI to non-SSRI was also strongly recommended. The combination of initial medication and other classes of antidepressants could benefit from treatment with TCAs, SSRIs, SNRIs, and noradrenergic and specific serotonergic antidepressants. Combination with norepinephrine and dopamine reuptake inhibitors or serotonin-2 antagonist/reuptake inhibitors was weakly recommended. The guideline strongly recommended use of the augmentation strategy of adding lithium or benzodiazepine to initial antidepressants. Augmentation of lamotrigine, T3, methylphenidate, and modafinil was weakly recommended. Conclusion If the initial outcomes of antidepressant therapy are unsatisfactory to the patients the next-step strategies of dose increment, switching, combination and augmentation of antidepressants should be considered after rechecking the patients’ drug compliance, dose, and diagnosis.

참고문헌 (68)

  1. Dupuy JM, "A critical review of pharmacotherapy for major depressive disorder", Int J Neuropsychopharmacol, 14, pp.1417~1431 (2011)
  2. Cipriani A, "Comparative efficacy and acceptability of 12 newgeneration antidepressants: a multiple-treatments meta-analysis", Lancet, 373, pp.746~758 (2009)
  3. Gaynes BN, "What did STAR*D teach us? Results from a large-scale, practical, clinical trial for patients with depression", Psychiatr Serv, 60, pp.1439~1445 (2009)
  4. Paykel ES, "Residual symptoms after partial remission: an important outcome in depression", Psychol Med, 25, pp.1171~1180 (1995)
  5. Gelenberg AJ, "A review of the current guidelines for depression treatment", J Clin Psychiatry, 71, pp.15~ (2010)
  6. Preskorn SH, "Treatment options for the patient who does not respond well to initial antidepressant therapy", J Psychiatr Pract, 15, pp.202~210 (2009)
  7. Lee MS LS, "The development of the Korean medication algorithm for major depressive disorder", Psychiatry Investig, 2, pp.60~69 (2005)
  8. Clinical Research Center for Depression, "Evidence-based Korean pharmacological treatment guideline for depression" (2008), ML Communication
  9. Clinical Research Center for Depression, "Evidence-based Korean non-pharmacological treatment guideline for depression" (2009), ML Communication
  10. Huang X, "Evaluation of PICO as a knowledge representation for clinical questions", AMIA Annu Symp Proc, pp.359~363 (2006)
  11. Kim SY KN, "ADAPTE: Manual for guildeline adaptation version 1.0" (2009), National Clinical Research Coordination Center
  12. Steering Committee for Clinical Practice Guideline, "Korean Appraisal of Guidelines for Research & Evaluation II" (2009), Ministry of Health & Welfare and Korean Academy of Medical Science
  13. Identification of Common Mental Disorders and Management of Depression in Primary Care, "New Zealand Guidelines Group", New Zealand: Ministry of Health, ~ (2008)
  14. National Institute for Health and Clinical Excellence, "Depression: the treatment and management of depression in adults" (2009), National Institute for Health and Clinical Experience
  15. American Psychiatric Association, "Practice Guideline for the treatment of Patients with major depressive disorder" (2010), American Psychiatric Association
  16. Anderson IM, "Evidence-based guidelines for treating depressive disorders with antidepressants: a revision of the 2000 British Association for Psychopharmacology guidelines", J Psychopharmacol, 22, pp.343~396 (2008)
  17. Bauer M, "World Federation of Societies of Biological Psychiatry (WFSBP) Guidelines for Biological Treatment of Unipolar Depressive Disorders in Primary Care", World J Biol Psychiatry, 8, pp.67~104 (2007)
  18. Lam RW, "Canadian Network for Mood and Anxiety Treatments (CANMAT) clinical guidelines for the management of major depressive disorder in adults. III. Pharmacotherapy", J Affect Disord, 117(1), pp.26~43 (2009)
  19. Texas Department of Mental Health and Mental Retardation (TDMHMR) in collaboration with Texa universities, "Texas Medication Algorithm Project Procedural Manual-Major Depressive Disorder Algorithms", ~ (2008)
  20. Korean Medication Algorithm Project for Depressive Disorder, "Korean Medication Algorithm for Depressive Disorder 2008", Korean Society for Depressive and Bipolar Disorders and Korean College of Neuropsychopharmacology, ~ (2008)
  21. Professional Development & Quality Assurance prepared by a group of family physicians, "Guideline on Management of Depression in Primary Care Hong Kong", ~ (2009)
  22. Malhi GS, "Clinical practice recommendations for depression", Acta Psychiatr Scand Suppl, pp.8~26 (2009)
  23. Dodd S, "To combine or not to combine? A literature review of antidepressant combination therapy", J Affect Disord, 89, pp.1~11 (2005)
  24. Furukawa TA, "Meta-analysis of effects and side effects of low dosage tricyclic antidepressants in depression: systematic review", BMJ, 325, pp.991~ (2002)
  25. Bollini P, "Effectiveness of antidepressants. Meta-analysis of dose-effect relationships in randomised clinical trials", Br J Psychiatry, 174, pp.297~303 (1999)
  26. Ramana R, "Medication received by patients with depression following the acute episode: adequacy and relation to outcome", Br J Psychiatry, 174, pp.128~134 (1999)
  27. Adli M, "Is dose escalation of antidepressants a rational strategy after a medium-dose treatment has failed? A systematic review", Eur Arch Psychiatry Clin Neurosci, 255, pp.387~400 (2005)
  28. Amsterdam JD, "High dose tranylcypromine therapy for refractory depression", Pharmacopsychiatry, 22, pp.21~25 (1989)
  29. Schatzberg AF, "Dosing strategies for antidepressant agents", J Clin Psychiatry, 52, pp.14~20 (1991)
  30. Tyrer P, "Clinical and pharmacokinetic factors affecting response to phenelzine", Br J Psychiatry, 136, pp.359~365 (1980)
  31. Angst J, "Moclobemide and tricyclic antidepressants in severe depression: meta-analysis and prospective studies", J Clin Psychopharmacol, 15(4)통권 : 2, pp.16~23 (1995)
  32. Fritze J, "Plasma moclobemide and metabolites: lack of correlation with clinical response and biogenic amines", Psychopharmacology (Berl), 99, pp.252~256 (1989)
  33. Gagiano CA, "Moclobemide twice daily in the treatment of major depressive episode: a double-blind, multicenter comparison with different three times daily dosage schedules", J Clin Psychopharmacol, 15(4 Suppl 2), pp.4S~9S (1995)
  34. Radat F, "Initial monoamine oxidase-A inhibition by moclobemide does not predict the therapeutic response in patients with major depression. A double blind, randomized study", Psychopharmacology (Berl), 127, pp.370~376 (1996)
  35. Bech P, "Citalopram dose-response revisited using an alternative psychometric approach to evaluate clinical effects of four fixed citalopram doses compared to placebo in patients with major depression", Psychopharmacology (Berl), 163, pp.20~25 (2002)
  36. Burke WJ, "Fixed-dose trial of the single isomer SSRI escitalopram in depressed outpatients", J Clin Psychiatry, 63, pp.331~336 (2002)
  37. Schweizer E, "What constitutes an adequate antidepressant trial for fluoxetine?", J Clin Psychiatry, 51, pp.8~11 (1990)
  38. Licht RW, "Treatment strategies in patients with major depression not responding to first-line sertraline treatment. A randomised study of extended duration of treatment, dose increase or mianserin augmentation", Psychopharmacology (Berl), 161, pp.143~151 (2002)
  39. Benkert O, "Dose escalation vs. continued doses of paroxetine and maprotiline: a prospective study in depressed out-patients with inadequate treatment response", Acta Psychiatr Scand, 95, pp.288~296 (1997)
  40. Rudolph RL, "A randomized, placebo-controlled, dose-response trial of venlafaxine hydrochloride in the treatment of major depression", J Clin Psychiatry, 59, pp.116~122 (1998)
  41. Schweizer E, "Placebo-controlled trial of venlafaxine for the treatment of major depression", J Clin Psychopharmacol, 11, pp.233~236 (1991)
  42. Rush AJ, "Bupropion-SR, sertraline, or venlafaxine-XR after failure of SSRIs for depression", N Engl J Med, 354, pp.1231~1242 (2006)
  43. Ruhé HG, "Switching antidepressants after a first selective serotonin reuptake inhibitor in major depressive disorder: a systematic review", J Clin Psychiatry, 67, pp.1836~1855 (2006)
  44. Tanghe A, "Moclobemide and amitriptyline, alone or in combination, in therapy resistant depression, Letter to the Editor" (1997), Human Psychopharmacology
  45. Nelson JC, "Combining norepinephrine and serotonin reuptake inhibition mechanisms for treatment of depression: a double-blind, randomized study", Biol Psychiatry, 55, pp.296~300 (2004)
  46. Lader M, "Combined use of tricyclic antidepressants and monoamine oxidase inhibitors", J Clin Psychiatry, 44(9)통권 : 2, pp.20~24 (1983)
  47. Carpenter LL, "A double-blind, placebo-controlled study of antidepressant augmentation with mirtazapine", Biol Psychiatry, 51, pp.183~188 (2002)
  48. McGrath PJ, "Tranylcypromine versus venlafaxine plus mirtazapine following three failed antidepressant medication trials for depression: a STAR*D report", Am J Psychiatry, 163, pp.1531~1666. (2006)
  49. Medhus A, "Mianserin added to tricyclic antidepressants in depressed patients not responding to a tricyclic antidepressant alone: a randomized, placebo-controlled, double-blind study", Nord J Psychiatry, 48, pp.335~358 (1994)
  50. Ferreri M, "Benefits from mianserin augmentation of fluoxetine in patients with major depression non-responders to fluoxetine alone", Acta Psychiatr Scand, 103, pp.66~72 (2001)
  51. Maes M, "Pindolol and mianserin augment the antidepressant activity of fluoxetine in hospitalized major depressed patients, including those with treatment resistance", J Clin Psychopharmacol, 19, pp.177~182 (1999)
  52. Licht RW, "Treatment strategies in patients with major depression not responding to first-line sertraline treatment. A randomised study of extended duration of treatment, dose increase or mianserin augmentation", Psychopharmacology, 161, pp.143~151 (2002)
  53. Trivedi MH, "Medication augmentation after the failure of SSRIs for depression", N Engl J Med, 354, pp.1243~1252 (2006)
  54. Lam RW, "Citalopram and bupropion- SR: combining versus switching in patients with treatmentresistant depression", J Clin Psychiatry, 65, pp.337~340 (2004)
  55. Maes M, "Efficacy of treatment with trazodone in combination with pindolol or fluoxetine in major depression", J Affect Disord, 41, pp.201~210 (1996)
  56. Crossley NA, "Acceleration and augmentation of antidepressants with lithium for depressive disorders: two meta-analyses of randomized, placebo-controlled trials", J Clin Psychiatry, 68, pp.935~940 (2007)
  57. Bauer M, "Double-blind, placebo-controlled trial of the use of lithium to augment antidepressant medication in continuation treatment of unipolar major depression", Am J Psychiatry, 157, pp.1429~1435 (2000)
  58. Birkenhäger TK, "Outcome of a 4-step treatment algorithm for depressed inpatients", J Clin Psychiatry, 67, pp.1266~1271 (2006)
  59. Schindler F, "Lithium versus lamotrigine augmentation in treatment resistant unipolar depression: a randomized, openlabel study", Int Clin Psychopharmacol, 22, pp.179~182 (2007)
  60. Joffe RT, "A placebo-controlled comparison of lithium and triiodothyronine augmentation of tricyclic antidepressants in unipolar refractory depression", Arch Gen Psychiatry, 50, pp.387~393 (1993)
  61. Altshuler LL, "Does thyroid supplementation accelerate tricyclic antidepressant response? A review and meta-analysis of the literature", Am J Psychiatry, 158, pp.1617~1622 (2001)
  62. Nierenberg AA, "A comparison of lithium and T(3) augmentation following two failed medication treatments for depression: a STAR*D report", Am J Psychiatry, 163, pp.1519~1665. (2006)
  63. Aronson R, "Triiodothyronine augmentation in the treatment of refractory depression. A meta-analysis", Arch Gen Psychiatry, 53, pp.842~848 (1996)
  64. Guaiana G, "Amitriptyline versus other types of pharmacotherapy for depression", Cochrane Database Syst Rev, pp.CD004186~ (2003)
  65. Furukawa TA, "Antidepressant and benzodiazepine for major depression", Cochrane Database Syst Rev, pp.CD001026~ (2002)
  66. Lavretsky H, "Methylphenidate- enhanced antidepressant response to citalopram in the elderly: a double-blind, placebo-controlled pilot trial", Am J Geriatr Psychiatry, 14, pp.181~185 (2006)
  67. Fava M, "Modafinil augmentation of selective serotonin reuptake inhibitor therapy in MDD partial responders with persistent fatigue and sleepiness", Ann Clin Psychiatry, 19, pp.153~159 (2007)
  68. DeBattista C, "Adjunct modafinil for the short-term treatment of fatigue and sleepiness in patients with major depressive disorder: a preliminary double-blind, placebo-controlled study", J Clin Psychiatry, 64, pp.1057~1064 (2003)

관련 논문AI추천

근거중심 한국형 우울증 약물학적 치료지침, 개정판(II) : 항우울제의 위약대비 효과, 항우울제간 효과차이 및 효과판정의 적정시점고영훈, 구재우, 박선철, 박용천, 백종우, 성승환, 심세훈, 오강섭, 원은수, 이강준, 이경민, 이문수, 이민수, 이화영, 전홍진, 최준호, 한규만, 한상우, 한창수, 함병주, 황태연대한신경정신의학회 · 신경정신의학2013 · 제52권 제5호근거중심 한국형 우울증 약물학적 치료지침, 개정판 (I) : 항우울제 치료의 초기선택고영훈, 박선철, 박용천, 백종우, 성승환, 심세훈, 오강섭, 원은수, 이강준, 이문수, 이민수, 이화영, 이희영, 전홍진, 최준호, 한규만, 한상우, 한창수, 함병주, 황태연대한신경정신의학회 · 신경정신의학2013 · 제52권 제4호한국형 우울장애 약물치료 알고리듬 2025 (I): 주요우울삽화의 치료전략김원, 김낙영, 김문두, 민경준, 박성용, 박원명, 서정석, 성형모, 심세훈, 양찬모, 왕성민, 우영섭, 윤보현, 이상열, 이정구, 전덕인, 정영은, 정종현, 최원석대한신경정신의학회 · 신경정신의학2025 · 제64권 제3호한국형 우울장애 약물치료 알고리듬 2021 (I): 주요우울삽화의 치료 전략김원, 민경준, 박영민, 박원명, 서정석, 성형모, 심세훈, 왕성민, 우영섭, 윤보현, 이상열, 이정구, 장승호, 전덕인, 정명훈, 정종현, 추일한대한신경정신의학회 · 신경정신의학2021 · 제60권 제3호한국형 우울장애 약물치료 알고리듬 2025 (II): 임상 아형김원, 김낙영, 김문두, 민경준, 박성용, 박원명, 서정석, 성형모, 양찬모, 왕성민, 우영섭, 윤보현, 이정구, 전덕인, 정영은, 정종현, 최원석대한신경정신의학회 · 신경정신의학2025 · 제64권 제3호Antidepressant Prescribing Patterns in Korea: Results from the Clinical Research Center for Depression Study김성완, 김재민, 배경열, 신일선, 윤진상, 이민수, 임현우, 전태연, 정성원대한신경정신의학회 · PSYCHIATRY INVESTIGATION2011 · 제8권 제3호

이 간행물의 다른 논문 (13건)

정신의학 문헌에서 살펴본 “조현(Attunement)”의 의미 : 현상학적-인류학적 시각에서 바라본 조현병손정우, 김용식, 정성훈pp. 279-291정신건강의학과 영역에서 사전동의함웅, 최원석, 오채근, 나경세, 정한용, 이강준pp. 292-300신경경제학과 정신의학 : 정량적 방법론의 적용박선철, 이선애pp. 301-310낮병원 치료가 조현병 환자의 치료충실도에 미치는 영향에 관한 전향적 연구최진훈, 안소현, 이선우, 김정란, 지익성, 왕성근pp. 311-317관해기 I형 양극성장애 환자와 발병하지 않은 일차 친족에서 신경인지의 결함김도훈, 조수현, 김지우, 원승희pp. 318-326
원문 보기