Open Access, Peer-reviewed
pISSN 1015-4817
eISSN 2289-0963
    J Korean Neuropsychiatr Assoc. 2013 Jul;52(4):253-262. Korean.
    Published online Jul 31, 2013.
    https://doi.org/10.4306/jknpa.2013.52.4.253
    Copyright © 2013 Korean Neuropsychiatric Association
    Original Article

    Evidence-Based Korean Pharmacological Treatment Guideline for Depression, Revised Edition (I) : Initial Choice of Antidepressant Treatment

    Seon-Cheol Park, MD, PhD,1 Seung-Hwan Sung, MD,2 Kyu-Man Han, MD,3 Eun-Soo Won, MD,3 Hwa-Young Lee, MD, PhD,2 Jong-Woo Paik, MD, PhD,4 Hong Jin Jeon, MD, PhD,5 Moon-Soo Lee, MD, PhD,6 Se-Hoon Shim, MD, PhD,2 Young-Hoon Ko, MD, PhD,7 Kang-Joon Lee, MD, PhD,8 Changsu Han, MD, PhD,7 Byung-Joo Ham, MD, PhD,3 Joonho Choi, MD, PhD,9 Heeyoung Lee, MD, MPH,10 Tae-Yeon Hwang, MD, PhD,1 Kang-Seob Oh, MD, PhD,11 Yong-Chon Park, MD, PhD,9 Min-Soo Lee, MD, PhD,3 and Sang-Woo Hahn, MD, PhD12
      • 1Department of Psychiatry, Yong-In Mental Hospital, Yongin, Korea.
      • 2Department of Psychiatry, College of Medicine, Soonchunhyang University, Cheonan Hospital, Cheonan, Korea.
      • 3Department of Psychiatry, College of Medicine, Korea University, Anam Hospital, Seoul, Korea.
      • 4Department of Psychiatry, School of Medicine, KyungHee University, KyungHee University Medical Center, Seoul, Korea.
      • 5Department of Psychiatry, School of Medicine, Sungkyunkwan University, Samsung Medical Center, Seoul, Korea.
      • 6Department of Psychiatry, College of Medicine, Korea University, Guro Hospital, Seoul, Korea.
      • 7Department of Psychiatry, College of Medicine, Korea University, Ansan Hospital, Ansan, Korea.
      • 8Department of Psychiatry, College of Medicine, Inje University, Ilsan Baik Hospital, Ilsan, Korea.
      • 9Department of Psychiatry, College of Medicine, Hanyang University, Guri Hospital, Guri, Korea.
      • 10Department of Cancer Control, Gachon University Gil Medical Center, Incheon, Korea.
      • 11Department of Psychiatry, School of Medicine, Sungkyunkwan University, Kangbuk Samsung Medical Center, Seoul, Korea.
      • 12Department of Psychiatry, College of Medicine, Soonchunhyang University, Seoul Hospital, Seoul, Korea.
    • Address for correspondence: Sang-Woo Hahn, MD, PhD, Department of Psychiatry, College of Medicine, Soonchunhyang University, Seoul Hospital, 59 Daesagwan-ro, Yongsan-gu, Seoul 140-743, Korea. Tel: +82-2-709-9234, Fax: +82-2-794-9414, Email: ha5hn@schmc.ac.kr
    Received June 20, 2013; Revised July 02, 2013; Accepted July 03, 2013.

    Abstract

    Objectives

    The aim of this study is to establish Korean pharmacological treatment guidelines for the initial choice of antidepressant for treatment of moderate or severe depression.

    Methods

    The process for establishment of guidelines involved determination of important key questions, selection of 12 international and domestic clinical practice guidelines for depression, drawing of recommendation drafts, and peer review.

    Results

    Selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), norepinephrine-dopamine reuptake inhibitors (NDRI), and noradrenergic and specific serotonergic antidepressants (NaSSA) were strongly recommended as the first-line antidepressants for treatment of moderate or severe depression. SSRIs were weakly recommended for patients who had problems with tolerability. Consideration of not only efficacy but also provisional adverse effects, drug-drug interactions, history of treatment response, preference, acceptability, cost, comorbid illnesses, and other factors in the choice of first-line antidepressants was strongly recommended. The treatment recommendations for specific clinical features of depression were as follows. SSRIs were weakly recommended for atypical depression. Augmented use of antipsychotics to antidepressants was strongly recommended for psychotic depression. Bupropion and SSRIs were weakly recommended for seasonal depression.

    Conclusion

    The results of this study may contribute toward improving the quality of depression treatment by providing clear and definite recommendations for the initial choice of antidepressant for treatment of moderate or severe depression.

    Keywords
    Depression; Pharmacological treatment; Antidepressant; Initial choice; Korean

    Figures

    Fig. 1
    Searching and selection of clinical practice guidelines for depression.

    Tables

    Table 1
    Twelve clinical practice guidelines for depression after the process of searching and selection

    Notes

    The authors have no financial conflicts of interest.

    Acknowledgments

    This study was supported by a grant of the Korean Health 21 Care Technology R & D Project, Ministry of Health and Welfare, Republic of Korea (A102065).

    References

      1. Lopez AD, Mathers CD, Ezzati M, Jamison DT, Murray CJL. In: Global burden of disease and risk factors. Washington (DC): World Bank; 2006.
      1. Lee MS, Lim SW, Cha JH, Chung SK, Kim KS, Kasper S. the Executive Committee for the Korean Medication Algorithm Project for Major Depressive Disorder. The development of the Korean medication algorithm for major depressive disorder. Psychiatry Investig 2005;2:60–69.
      1. Clinical Research Center for Depression. Evidence-based Korean pharmacological treatment guideline for depression. Seoul: ML Communication; 2008.
      1. Clinical Research Center for Depression. Evidence-based Korean non-pharmacological treatment guideline for depression. Seoul: ML Communication; 2009.
      1. Clinical Research Center for Depression. Evidence-based Korean pharmacological treatment guideline for depression, revised edition. Seoul: ML Communication; 2012.
      1. Huang X, Lin J, Demner-Fushman D. Evaluation of PICO as a knowledge representation for clinical questions. AMIA Annu Symp Proc 2006:359–363.
      1. Kim SY, Kim NS, Shin SS, Kim DW, Ji SM, Lee SJ. In: ADAPTE: Manual for guildeline adaptation version 1.0. Seoul: National Clinical Research Coordination Center; 2009.
      1. Steering Committee for Clinical Practice Guideline. Korean Appraisal of Guidelines for Research & Evaluation II. Seoul: Ministry of Health & Welfare and Korean Academy of Medical Science; 2009.
      1. Guyatt GH, Oxman AD, Kunz R, Falck-Ytter Y, Vist GE, Liberati A, et al. Going from evidence to recommendations. BMJ 2008;336:1049–1051.
      1. New Zealand Guidelines Group. Identification of Common Mental Disorders and Management of Depression in Primary Care. Wellington: Ministry of Health, New Zealand; 2008.
      1. National Institute for Health and Clinical Excellence (NICE). Depression: the treatment and management of depression in adults (National Clinical Practice Guideline 90). London: National Institute for Health and Clinical Experience; 2009.
      1. Lam RW, Kennedy SH, Grigoriadis S, McIntyre RS, Milev R, Ramasubbu R, et al. Canadian Network for Mood and Anxiety Treatments (CANMAT) clinical guidelines for the management of major depressive disorder in adults. III. Pharmacotherapy. J Affect Disord 2009;117 Suppl 1:S26–S43.
      1. American Psychiatric Association (APA). Practice Guideline for the treatment of Patients with major depressive disorder. 3rd ed. Arlington: American Psychiatric Association (APA); 2010.
      1. Anderson IM, Ferrier IN, Baldwin RC, Cowen PJ, Howard L, Lewis G, et al. Evidence-based guidelines for treating depressive disorders with antidepressants: a revision of the 2000 British Association for Psychopharmacology guidelines. J Psychopharmacol 2008;22:343–396.
      1. Professional Development & Quality Assurance prepared by a group of family physicians. Guideline on Management of Depression in Primary Care Hong Kong. 2009.
      1. Qaseem A, Snow V, Denberg TD, Forciea MA, Owens DK. Clinical Efficacy Assessment Subcommittee of American College of Physicians. Using second-generation antidepressants to treat depressive disorders: a clinical practice guideline from the American College of Physicians. Ann Intern Med 2008;149:725–733.
      1. Malhi GS, Adams D, Porter R, Wignall A, Lampe L, O'Connor N, et al. Clinical practice recommendations for depression. Acta Psychiatr Scand Suppl 2009:8–26.
      1. Texas Department of Mental Health and Mental Retardation (TDMHMR) in collaboration with Texas universities. Texas Medication Algorithm Project Procedural Manual - Major Depressive Disorder Algorithms. 2008.
      1. Bauer M, Bschor T, Pfennig A, Whybrow PC, Angst J, Versiani M, et al. World Federation of Societies of Biological Psychiatry (WFSBP) Guidelines for Biological Treatment of Unipolar Depressive Disorders in Primary Care. World J Biol Psychiatry 2007;8:67–104.
      1. Korean Medication Algorithm Project for Depressive Disorder. Korean Medication Algorithm for Depressive Disorder 2008. Korean Society for Depressive and Bipolar Disorders and Korean College of Neuropsychopharmacology; 2008.
      1. Montgomery SA. A meta-analysis of the efficacy and tolerability of paroxetine versus tricyclic antidepressants in the treatment of major depression. Int Clin Psychopharmacol 2001;16:169–178.
      1. Puech A, Montgomery SA, Prost JF, Solles A, Briley M. Milnacipran, a new serotonin and noradrenaline reuptake inhibitor: an overview of its antidepressant activity and clinical tolerability. Int Clin Psychopharmacol 1997;12:99–108.
      1. Anderson IM. Selective serotonin reuptake inhibitors versus tricyclic antidepressants: a meta-analysis of efficacy and tolerability. J Affect Disord 2000;58:19–36.
      1. Simon GE, VonKorff M, Heiligenstein JH, Revicki DA, Grothaus L, Katon W, et al. Initial antidepressant choice in primary care. Effectiveness and cost of fluoxetine vs tricyclic antidepressants. JAMA 1996;275:1897–1902.
      1. Cipriani A, Furukawa TA, Salanti G, Geddes JR, Higgins JP, Churchill R, et al. Comparative efficacy and acceptability of 12 new-generation antidepressants: a multiple-treatments meta-analysis. Lancet 2009;373:746–758.
      1. Anderson IM. Meta-analytical studies on new antidepressants. Br Med Bull 2001;57:161–178.
      1. Anderson IM, Nutt DJ, Deakin JF. Evidence-based guidelines for treating depressive disorders with antidepressants: a revision of the 1993 British Association for Psychopharmacology guidelines. British Association for Psychopharmacology. J Psychopharmacol 2000;14:3–20.
      1. Bech P, Cialdella P, Haugh MC, Birkett MA, Hours A, Boissel JP, et al. Meta-analysis of randomised controlled trials of fluoxetine v. placebo and tricyclic antidepressants in the short-term treatment of major depression. Br J Psychiatry 2000;176:421–428.
      1. Peretti S, Judge R, Hindmarch I. Safety and tolerability considerations: tricyclic antidepressants vs. selective serotonin reuptake inhibitors. Acta Psychiatr Scand Suppl 2000;403:17–25.
      1. Vaswani M, Linda FK, Ramesh S. Role of selective serotonin reuptake inhibitors in psychiatric disorders: a comprehensive review. Prog Neuropsychopharmacol Biol Psychiatry 2003;27:85–102.
      1. Williams JW Jr, Mulrow CD, Chiquette E, Noël PH, Aguilar C, Cornell J. A systematic review of newer pharmacotherapies for depression in adults: evidence report summary. Ann Intern Med 2000;132:743–756.
      1. Montgomery SA, Henry J, McDonald G, Dinan T, Lader M, Hindmarch I, et al. Selective serotonin reuptake inhibitors: meta-analysis of discontinuation rates. Int Clin Psychopharmacol 1994;9:47–53.
      1. Song F, Freemantle N, Sheldon TA, House A, Watson P, Long A, et al. Selective serotonin reuptake inhibitors: meta-analysis of efficacy and acceptability. BMJ 1993;306:683–687.
      1. Henkel V, Mergl R, Allgaier AK, Kohnen R, Möller HJ, Hegerl U. Treatment of depression with atypical features: a meta-analytic approach. Psychiatry Res 2006;141:89–101.
      1. Joyce PR, Mulder RT, Luty SE, Sullivan PF, McKenzie JM, Abbott RM, et al. Patterns and predictors of remission, response and recovery in major depression treated with fluoxetine or nortriptyline. Aust N Z J Psychiatry 2002;36:384–391.
      1. Taner E, Demir EY, Cosar B. Comparison of the effectiveness of reboxetine versus fluoxetine in patients with atypical depression: a single-blind, randomized clinical trial. Adv Ther 2006;23:974–987.
      1. Ayuso-Gutiérrez JL. Depressive subtypes and efficacy of antidepressive pharmacotherapy. World J Biol Psychiatry 2005;6 Suppl 2:31–37.
      1. Dannon PN, Lowengrub K, Gonopolski Y, Kotler M. Current and emerging somatic treatment strategies in psychotic major depression. Expert Rev Neurother 2006;6:73–80.
      1. Wijkstra J, Lijmer J, Balk FJ, Geddes JR, Nolen WA. Pharmacological treatment for unipolar psychotic depression: systematic review and meta-analysis. Br J Psychiatry 2006;188:410–415.
      1. Wijkstra J, Lijmer J, Balk FJ, Geddes J, Nolen WA. Pharmacological treatment for unipolar psychotic depression: systematic review and meta-analysis. Cochrane Database Syst Rev 2005:CD004044.
      1. Modell JG, Rosenthal NE, Harriett AE, Krishen A, Asgharian A, Foster VJ, et al. Seasonal affective disorder and its prevention by anticipatory treatment with bupropion XL. Biol Psychiatry 2005;58:658–667.
      1. Moscovitch A, Blashko CA, Eagles JM, Darcourt G, Thompson C, Kasper S, et al. A placebo-controlled study of sertraline in the treatment of outpatients with seasonal affective disorder. Psychopharmacology (Berl) 2004;171:390–397.
      1. Lam RW, Gorman CP, Michalon M, Steiner M, Levitt AJ, Corral MR, et al. Multicenter, placebo-controlled study of fluoxetine in seasonal affective disorder. Am J Psychiatry 1995;152:1765–1770.
      1. Partonen T, Lönnqvist J. Moclobemide and fluoxetine in treatment of seasonal affective disorder. J Affect Disord 1996;41:93–99.
      1. Gelenberg AJ, Hopkins HS. Assessing and treating depression in primary care medicine. Am J Med 2007;120:105–108.
      1. Mace S, Taylor D. Selective serotonin reuptake inhibitors: a review of efficacy and tolerability in depression. Expert Opin Pharmacother 2000;1:917–933.
      1. Ray WA, Meredith S, Thapa PB, Hall K, Murray KT. Cyclic antidepressants and the risk of sudden cardiac death. Clin Pharmacol Ther 2004;75:234–241.
      1. Mulrow CD, Williams JW Jr, Chiquette E, Aguilar C, Hitchcock-Noel P, Lee S, et al. Efficacy of newer medications for treating depression in primary care patients. Am J Med 2000;108:54–64.
      1. Mulder RT, Watkins WG, Joyce PR, Luty SE. Age may affect response to antidepressants with serotonergic and noradrenergic actions. J Affect Disord 2003;76:143–149.
    Cited by
    Crossref 4
    Google Scholar 
    MeSH Terms
    Antidepressive Agents
    Antipsychotic Agents
    Bupropion
    Depression
    Humans
    Seasons
    Serotonin Uptake Inhibitors
    Metrics
    Share
    Figures
    slide

    1 / 1

    Tables
    slide

    1 / 1

    PERMALINK