Korean Medication Algorithm Project for Depressive Disorder 2021 (V): Antidepressant Choices According to Safety, Adverse Effect, Comorbid Physical Illnesses and Clinical Definitionof Treatment Resistant Depression
10.4306/jknpa.2021.60.4.267
- Author:
Myung Hun JUNG
1
;
Jung Goo LEE
;
Won-Myong BAHK
;
Young Sup WOO
;
Sheng-Min WANG
;
Jong-Hyun JEONG
;
Won KIM
;
Se-Hoon SHIM
;
Jeong Seok SEO
;
Seung-Ho JANG
;
Chan-Mo YANG
;
Young-Min PARK
;
Hyung Mo SUNG
;
IL Han CHOO
;
Bo-Hyun YOON
;
Sang-Yeol LEE
;
Duk-In JON
;
Kyung Joon MIN
Author Information
1. Department of Psychiatry, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
- Publication Type:ORIGINAL ARTICLE
- From:Journal of Korean Neuropsychiatric Association
2021;60(4):267-274
- CountryRepublic of Korea
- Language:English
-
Abstract:
Objectives:To revise Korean Medication Algorithm Project for Depressive Disorder 2017 (KMAPDD 2017) guidelines by revising antidepressant choices based on their safety, adverse effects, comorbid physical illnesses, and the clinical definition of treatment-resistant depression (TRD).
Methods:A 33-item questionnaire comprised of six parts was developed. A 65-expert consensus (65/97, 67.0%) was obtained on pharmacological treatment strategies regarding antidepressant choice with respect to safety, adverse effects, and comorbid physical illnesses. Multiple response sets were subjected to statistical analysis.
Results:The results obtained showed that first-line pharmacotherapeutic strategies based on various clinical considerations were as follows: mirtazapine (for patients with increased suicidality, Gastrointestinal discomfort, and insomnia), bupropion (for patients with orthostatic hypotension, history of a safety accident, serotonin syndrome, sedation, sexual dysfunction, and weight gain), and escitalopram (for patients with anticholinergic side effects). For patients exhibiting comorbid conditions, duloxetine was the first line pharmacotherapeutic strategy for chronic pain, escitalopram was the first-line pharmacotherapeutic strategy for diabetes, hypertension, liver disease, Parkinson’s disease, renal disease, epilepsy, and thyroid disease, and sertraline was a first-line pharmacotherapeutic strategy for arrhythmia and cardiovascular disease.
Conclusion:Pharmacological treatment strategy of KMAP-DD 2021 is similar to that of KMAPDD 2017. Additional study is required to determine antidepressant choices for TRD and cancer patients with depression.
