Evidence-Based Korean Pharmacological Treatment Guideline for Depression, Revised Edition (III) : Dose Increment, Switching, Combination, and Augmentation Strategy in Antidepressant Therapy

Kyu-Man Han; 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

doi:10.4306/jknpa.2013.52.5.386

Journal List > J Korean Neuropsychiatr Assoc > v.52(5) > 1017654

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Han, Park, Won, Sung, Lee, Koo, Lee, Lee, Paik, Jeon, Lee, Shim, Ko, Lee, Han, Ham, Choi, Hwang, Oh, Hahn, Park, and Lee: Evidence-Based Korean Pharmacological Treatment Guideline for Depression, Revised Edition (III) : Dose Increment, Switching, Combination, and Augmentation Strategy in Antidepressant Therapy

Original Article

Journal of Korean Neuropsychiatric Association 2013; 52(5): 386-401.

Published online: 30 September 2013

DOI: https://doi.org/10.4306/jknpa.2013.52.5.386

Evidence-Based Korean Pharmacological Treatment Guideline for Depression, Revised Edition (III) : Dose Increment, Switching, Combination, and Augmentation Strategy in Antidepressant Therapy

Kyu-Man Han, MD¹, Seon-Cheol Park, MD, PhD², Eun-Soo Won, MD¹, Seung-Hwan Sung, MD³, Heeyoung Lee, MD, MPH⁴, Jae-Woo Koo, MD², Kyungmin Lee, MD², Hwa-Young Lee, MD, PhD³, Jong-Woo Paik, MD, PhD⁵, Hong Jin Jeon, MD, PhD⁶, Moon-Soo Lee, MD, PhD¹, Se-Hoon Shim, MD, PhD³, Young-Hoon Ko, MD, PhD¹, Kang-Joon Lee, MD, PhD⁷, Changsu Han, MD, PhD¹, Byung-Joo Ham, MD, PhD¹, Joonho Choi, MD, PhD⁸, Tae-Yeon Hwang, MD, PhD², Kang-Seob Oh, MD, PhD⁶, Sang-Woo Hahn, MD, PhD³, Yong-Chon Park, MD, PhD⁸, Min-Soo Lee, MD, PhD¹

¹Department of Psychiatry, College of Medicine, Korea University, Seoul, Korea.

²Department of Psychiatry, Yong-In Mental Hospital, Yongin, Korea.

³Department of Psychiatry, College of Medicine, Soonchunhyang University, Cheonan, Korea.

⁴Department of Cancer Management, Gachon University Gil Medical Center, Incheon, Korea.

⁵Department of Psychiatry, School of Medicine, KyungHee University, Seoul, Korea.

⁶Department of Psychiatry, School of Medicine, Sungkyunkwan University, Seoul, Korea.

⁷Department of Psychiatry, College of Medicine, Inje University, Busan, Korea.

⁸Department of Psychiatry, College of Medicine, Hanyang University, Seoul, Korea.

Address for correspondence: Min-Soo Lee, MD, PhD. Department of Psychiatry, College of Medicine, Korea University, Korea University Anam Hospital, 73 Inchon-ro, Seongbuk-gu, Seoul 136-705, Korea. Tel: +82-2-920-5354, Fax: +82-2-923-3507, leeminso@korea.ac.kr

Received 19 June 2013 Revised 1 July 2013 Accepted 4 July 2013

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.

Keywords: Major depressive disorder, Guideline, Antidepressant, Switching, Combination, Augmentation

Figures and Tables

Table 1

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

Table 2

Evidence levels and recommendation level of twelve clinical practice guidelines for depression

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).

Notes

The authors have no financial conflicts of interest.

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