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

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

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.

Figures and Tables

Table 1
Twelve clinical practice guidelines for depression after the process of searching and selection
jkna-52-386-i001
Table 2
Evidence levels and recommendation level of twelve clinical practice guidelines for depression
jkna-52-386-i002

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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