Korea University Anam Hospital, Department of Psychiatry, Seoul, South Korea
The appropriate psychopharmacological therapy is essential to treat patients with depression effectively. However, the treatment of depression has not been systematized, thus, it depends on the experience of individual psychiatry practitioners. In order to suggest therapeutic algorithms systematically, clinical practice guideline of depression have been developed. The Korean Medication Algorithm Project for Depressive Disorder 2017 (KMAP-DD 2017) is under development in South Korea in 2017. The KMAP-DD 2017 has revised the KMAP-DD 2012 to reflect the latest findings on treatment of depression. A total of 144 psychiatrists with depressive disorders were enrolled in the KMAP-DD 2017 survey. Sertraline or escitalopram monotherapy was selected as the first-line treatment for mild and moderate depressive episodes. Treatment with escitalopram, venlafaxine or mirtazapine alone for severe depressive episodes without psychotic symptoms, and aripiprazole or quetiapine combination therapy was chosen as the first-line treatment. For psychotic depression, antidepressant augmented with atypical antipsychotics was selected as first-line treatment for initial treatment. When treatment response is inadequate in first-line treatment, substitution with other antidepressants, switching to another atypical antipsychotics, or the addition of other antidepressants has been selected as the first-line treatment. For maintenance therapy, most clinicians prefer to maintain antidepressant medication for substantial duration after achieving remission. For patients with history of more depressive episode, many clinicians prefer to maintain antidepressant continuously. The maintenance of antipsychotics is also preferred, but the duration is shorter than antidepressants. The dose of antidepressant in maintenance treatment is about 75% of the dose in acute treatment, and the dose of antipsychotics is about 50%.