Korean Medication Algorithm for Depressive Disorder 2025, Fifth Revision: An Executive Summary
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Objective: Since its development in 2002 by the Korean College of Neuropsychopharmacology and the Korean Society for Affective Disorders, the Korean Medication Algorithm Project for Depressive Disorder (KMAP-DD) has undergone five revisions. Methods: To improve survey efficiency, reflect general clinical practice, and facilitate comparisons with previous KMAP-DD revisions, the overall structure of the questionnaire was retained. The six sections of the questionnaire were as follows: 1) pharmacological treatment strategies for major depressive disorder with and without psychotic features; 2) pharmaco logical treatment strategies for persistent depressive disorder and other depressive disorder subtypes; 3) consensus on treat ment-resistant depression; 4) selection of an antidepressant in consideration of safety, adverse effects, and comorbid phys ical conditions; 5) treatment strategies for special populations (children/adolescents, elderly, and women); and 6) non-phar macological biological therapies. First-, second-, and third-line treatment recommendations were statistically derived. Results: Compared to KMAP-DD 2021, only minor changes were noted, due to the limited introduction of new medi cations or treatment modalities. Nonetheless, notable shifts included an increased preference for atypical antipsychotics (AAPs), and higher preference of combination strategies involving AAPs and mood stabilizers, indicating a more proac tive and intensive treatment trend in Korea. Conclusion: KMAP-DD is expected to serve as a valuable clinical resource by providing expert consensus-based recom mendations on specific treatment strategies and pharmacological options for major depressive disorders, thereby support ing the integration of real-world clinical practice with evidence-based medicine.
Abstract
Objective: Since its development in 2002 by the Korean College of Neuropsychopharmacology and the Korean Society for Affective Disorders, the Korean Medication Algorithm Project for Depressive Disorder (KMAP-DD) has undergone five revisions. Methods: To improve survey efficiency, reflect general clinical practice, and facilitate comparisons with previous KMAP-DD revisions, the overall structure of the questionnaire was retained. The six sections of the questionnaire were as follows: 1) pharmacological treatment strategies for major depressive disorder with and without psychotic features; 2) pharmaco logical treatment strategies for persistent depressive disorder and other depressive disorder subtypes; 3) consensus on treat ment-resistant depression; 4) selection of an antidepressant in consideration of safety, adverse effects, and comorbid phys ical conditions; 5) treatment strategies for special populations (children/adolescents, elderly, and women); and 6) non-phar macological biological therapies. First-, second-, and third-line treatment recommendations were statistically derived. Results: Compared to KMAP-DD 2021, only minor changes were noted, due to the limited introduction of new medi cations or treatment modalities. Nonetheless, notable shifts included an increased preference for atypical antipsychotics (AAPs), and higher preference of combination strategies involving AAPs and mood stabilizers, indicating a more proac tive and intensive treatment trend in Korea. Conclusion: KMAP-DD is expected to serve as a valuable clinical resource by providing expert consensus-based recom mendations on specific treatment strategies and pharmacological options for major depressive disorders, thereby support ing the integration of real-world clinical practice with evidence-based medicine.