근거중심 한국형 우울증 약물학적 치료지침, 개정판(III) : 항우울제의 증량, 교체, 병합 및 강화요법

• 영문명: Evidence-Based Korean Pharmacological Treatment Guideline for Depression, Revised Edition (III) : Dose Increment, Switching, Combination, and Augmentation Strategy in Antidepressant Therapy
• 발행기관: 대한신경정신의학회
• 저자명: 한규만 박선철 원은수 성승환 이희영 구재우 이경민 이화영 백종우 전홍진 이문수 심세훈 고영훈 이강준 한창수 함병주 최준호 황태연 오강섭 한상우 박용천 이민수
• 간행물 정보: 『신경정신의학』제52권 제5호, 386~401쪽, 전체 16쪽
• 주제분류: 의약학 > 정신과학
• 파일형태: PDF
• 발행일자: 2013.09.30

영문 초록

ObjectivesZZThe 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. MethodsZZThe 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. ResultsZZThe 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. ConclusionZZIf 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.

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REFERENCES

키워드

Major depressive disorder Guideline Antidepressant Switching Combination Augmentation