Evidence-Based Korean Pharmacological Treatment Guideline for Depression, Revised Edition (III) : Dose Increment, Switching, Combination, and Augmentation Strategy in Antidepressant Therapy.
10.4306/jknpa.2013.52.5.386
- Author:
Kyu Man HAN
1
;
Seon Cheol PARK
;
Eun Soo WON
;
Seung Hwan SUNG
;
Heeyoung LEE
;
Jae Woo KOO
;
Kyungmin LEE
;
Hwa Young LEE
;
Jong Woo PAIK
;
Hong Jin JEON
;
Moon Soo LEE
;
Se Hoon SHIM
;
Young Hoon KO
;
Kang Joon LEE
;
Changsu HAN
;
Byung Joo HAM
;
Joonho CHOI
;
Tae Yeon HWANG
;
Kang Seob OH
;
Sang Woo HAHN
;
Yong Chon PARK
;
Min Soo LEE
Author Information
1. Department of Psychiatry, College of Medicine, Korea University, Seoul, Korea. leeminso@korea.ac.kr
- Publication Type:Original Article
- Keywords:
Major depressive disorder;
Guideline;
Antidepressant;
Switching;
Combination;
Augmentation
- MeSH:
Antidepressive Agents;
Antidepressive Agents, Tricyclic;
Benzhydryl Compounds;
Benzodiazepines;
Compliance;
Depression*;
Depressive Disorder, Major;
Dopamine Uptake Inhibitors;
Drug Therapy;
Humans;
Lithium;
Methylphenidate;
Monoamine Oxidase Inhibitors;
Norepinephrine;
Serotonin;
Serotonin Uptake Inhibitors;
Triazines
- From:Journal of Korean Neuropsychiatric Association
2013;52(5):386-401
- CountryRepublic of Korea
- Language:Korean
-
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.
