한국형 우울장애 약물치료 알고리듬 2025 (VI): 비약물학적 생물치료

Abstract

Objectives The Korean Medication Algorithm Project for Depressive Disorder (KMAP-DD) 2025 was under taken to provide updates of KMAP-DD 2021. This study focused on non-pharmacological biological treatments. Methods A total of 136 psychiatrists with vast clinical experience and academic publications in the non-pharmacological biological treatment of depressive disorder were primarily selected, and then the survey questionnaire was sent to them via mail, and 97 responses were received. Results Electroconvulsive therapy (ECT) was recommended as a first-line treatment strategy for major depressive disorders, severe with/without psychotic features with urgent suicidal risk, severe episodes with psychotic features in pregnant patients, and non-responders to pharmacotherapy with moderate episodes, as a second-line strategy for non-responders on antidepressant monotherapy or combination therapy, and combined with physical illness in severe episodes. For pregnant women with severe episodes of major depressive disorders, repetitive transcranial magnetic stimulation (rTMS) was preferred as a first-line strategy. However, in all other situations investigated (non-responders on combination therapy of antipsychotics and antidepressants, with comorbid physical illness, and initial treatment for antidepressant naive patients) were second-lines. Complementary or novel treatment was not recommended as the first or second-line treatment strategy for depressive disorder. Conclusion ECT and rTMS were the first-line strategies in specific clinical situations. The preference for ECT and rTMS gradually increased when compared with the previous algorithms. Complementary or novel treatments such as transcranial direct current stimulation, light therapy, nutritional therapy, vagus nerve stimulation, and deep brain stimulation were the third-line strategies, and their practical use seems to be still limited.