한국형 우울장애 약물치료 알고리듬 2025 (I): 주요우울삽화의 치료전략

Abstract

Objectives The Korean Medication Algorithm Project for Depressive Disorder 2025 (KMAP-DD 2025) was developed to provide updated, consensus-based pharmacological treatment guidelines for major depressive disorders in Korea, reflecting recent clinical evidence and domestic practice patterns. Methods Survey data for the KMAP-DD 2025 were collected through a structured expert consensus process based on the RAND/UCLA appropriateness method. A revised questionnaire was sent to 206 experienced Korean psychiatrists, and responses from 97 psychiatrists and 42 child/adolescent psychiatry specialists were analyzed to arrive at a consensus on pharmacological strategies for major depressive episodes (MDE). Results For mild-to-moderate MDE, antidepressant (AD) monotherapy was recommended as the treatment of choice (TOC), with combination therapies involving mood stabilizers or atypical antipsychotics (AAP) as secondary options. In severe non-psychotic episodes, AD monotherapy, AD plus AAP, and dual AD therapy were all first-line options, while for severe psychotic episodes, AD plus AAP was the TOC. Escitalopram was consistently preferred as the first-line AD, and aripiprazole and quetiapine as leading AAPs. If initial treatments failed, strategies included switching or augmenting with another AD, AAP, or augmentation agents such as lithium, which remained the preferred third-line option. Conclusion Compared to the previous editions, KMAP-DD 2025 showed an increased preference for early combination therapies, especially in more severe or psychotic depression, and a higher reliance on AAPs. These recommendations reflect the evolving clinical trends and the need for practical, context-specific guidance in Korean practice.