Dialectical Behavior Therapy. The Complete Idiot's Guide. Teach Yourself. FREE Shipping. Last 30 days Last 90 days Coming Soon. Include Out of Stock. Fast, FREE delivery, video streaming, music, and much more. Back to top. Get to Know Us. Amazon Payment Products. English Choose a language for shopping. Amazon Music Stream millions of songs. Amazon Advertising Find, attract, and engage customers. Amazon Drive Cloud storage from Amazon. The US National Institute of Mental Health offers severe mood dysregulation, and DSM-5 newly recognizes a disorder including two key symptoms, severe recurrent temper outbursts, and persistent irritability observable by others.
There was no first-line strategy for DMDD and a lack of evidence, but some positive results have been reported with psychostimulants, with an ongoing divalproex sodium trial for ADHD and an adjunctive risperidone trial for tic disorder. In treating tic disorder, aripiprazole is more favorable than risperidone in terms of side effects.
Aripiprazole and risperidone were recommended as first-line AAPs for psychotic severe depression. However, it is not clear whether AD therapy is as effective in children and adolescents as it is in adults; furthermore, ADs may increase the risk of suicide or self-harm in adolescents 18 and may adversely affect young patients with bipolar disorder, particularly those who experienced the onset of depression before 24 years of age.
Korean Medication Algorithm for Depressive Disorders 2017: Third Revision
In this revision, the first-line ADs for children and adolescents with MDD were escitalopram and fluoxetine. Aripiprazole and quetiapine were first-line AAP for elderly psychotic depression. Adjunctive aripiprazole with various ADs was found effective for elderly depression. Despite lack of evidence in treating elderly depression, it is clear that certain factors should be considered.
Aging has an effect on the incidence and treatment outcomes of depression; the drug-drug interactions resulting from polypharmacy and the various comorbid physical illnesses should be taken into account. The survey of MDD in pregnancy is a new section in this revision. MDD treatment should be chosen in light of a clear benefit-risk evaluation, taking into account possible harmful effects of the drugs on the fetus, potential malnutrition without MDD treatment, and risk of substance abuse including tobacco.
The ADs with the least influence on postpartum and breast-feeding, such as escitalopram and sertraline 75 were also recommended by the Korean experts. TMS was also a second strategy for non-responder on AD combination therapy in severe episodes without psychotic features, and for non-responders to pharmacotherapy in moderate episodes. Most Korean experts consider ECT However, the executive committee recommended that ECT could be applied when depressed patients have potential suicidality or attempt.
The frequencies of use of adjunctive complementary agents such as phototherapy, omega-3 nutritional therapy, and megavitamin with initial treatment drugs were When used as adjunctives for TRD, the frequencies were Although the frequency of use of phototherapy was very low, CANMAT recommended monotherapy with phototherapy as a first-line treatment for seasonal MDD and mono- or adjunctive phototherapy as a second-line treatment for non-seasonal, mild-to-moderate MDD. A major limitation of the present study is that it was based on the consensus of Korean experts rather than on evidence.
As stated earlier, we believe that the expert consensus and the evidence-based guidelines are complimentary, not contradictory. However, given that there are only 3, psychiatrists in Korea and given that the total membership of the KSAD is only , a sample of psychiatrists may be sufficient. Finally, we did not explore psychosocial approaches, which should be addressed in a future study.
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Moreover, recommendations for specific ADs according to population, side effects, and safety issues reflect recent evidence. We expect it to provide clinicians with useful information about the specific strategies and medications appropriate for treating patients with MDD. Though we have already published the papers in Korea, we decided to present and share the results with the experts who speak English according to conditions for acceptable secondary publications as stated in Uniform Requirements for Manuscripts Submitted to Biomedical Journals by International Committee of Medical Journal Editors.
This research did not receive any specific grant from funding agencies in the commercial sector. The authors report no conflicts of interest in this work. National Center for Biotechnology Information , U. Journal List Clin Psychopharmacol Neurosci v. Clin Psychopharmacol Neurosci.
Depressive Disorders : WPA Series Evidence and Experience in Psychiatry
Published online Feb Author information Article notes Copyright and License information Disclaimer. Corresponding author. Received Jul 12; Accepted Aug 1. This article has been cited by other articles in PMC. Abstract Objective In , the Korean Society for Affective Disorders developed the guidelines for the treatment of major depressive disorder MDD , and revised it in and Methods Using a item questionnaire, an expert consensus was obtained on pharmacological treatment strategies for MDD 1 without or 2 with psychotic features, 3 depression subtypes, 4 maintenance, 5 special populations, 6 the choice of an antidepressant AD regarding safety and adverse effects, and 7 non-pharmacological biological therapies.
Conclusion The pharmacological treatment strategy in is similar to that of Korean Medication Algorithm for Depressive Disorder Keywords: Algorithms, Depressive disorder, Drug therapy, Guideline. Table 1 Comparison among first , second , and third revisions of the Korean Medication Algorithm for Depressive Disorder. Open in a separate window.
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TCA, tricyclic antidepressant. Rating Scale Each treatment option was scored on a nine-point scale. Data Analysis Mean of each question or option were calculated. Development of Treatment Guidelines and Algorithms After discussing these results and reviewing the current evidences, considering Korean clinical situations, the executive committee drew up the third revised KMAP-DD algorithms Figs.
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Ethics The present study was conducted according to the Declaration of Helsinki. Second strategies when initial strategies have no or partial response Table 4 Comparison of preference of antipsychotics in the Korean Medication Algorithm for Depressive Disorder.
AD choice in light of adverse effects, safety, and comorbid physical illness We asked the experts to choose three ADs when considering adverse effect, drug safety, and comorbid physical illness, respectively. Duration of maintenance treatment of psychotic depression after remission Table 5 Table 5 Duration of maintenance treatment. AD choice according subtype of depressive episode For the patients with melancholic features, escitalopram and venlafaxine were the TOC and fluoxetine, paroxetine, sertraline, duloxetine, milnacipran, desvenlafaxine, and mirtazapine were the first-line ADs.
Treatment strategies and AD choice according specifiers, mixed features and anxious distress in depressive episode Table 6 Table 6 Initial treatment strategies and drugs of choice for anxious distress or mixed features.
Treatment Strategies for Special Populations Table 7 Table 7 Treatment strategies for major depressive disorder in special populations. Women with depressive disorder AD monotherapy was the first-line treatment option for premenstrual dysphoric disorder PMDD. Indications of electro-convulsive therapy. Indications for rTMS Fig.
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Indications of repetitive transcranial magnetic stimulation. Choice of complementary or novel agents for treatment-resistant depressive disorder Light therapy, nutritional therapy omega-3, megavitamin , vagus nerve stimulation, S-adenosylmethionine, deep brain stimulation, and sleep deprivation were considered as second-line treatment options for MDD. Duration of maintenance treatment after remission: psychotic depression Table 6 The notion that the duration of the initial AD treatment depends on the number of recurring episodes of psychotic depression did not change over , , and Treatment strategies specific to subtype Melancholia Little information about the most effective agents for the melancholic and atypical subtypes is available.
Treatment strategies for specifiers mixed feature and anxious distress Table 6 The survey on specifiers is a newly added set of questions in this revision. Field M, Lohr KN. Guidelines for clinical practice: from development to use. Washington, D. C: National Academy Press; J Affect Disord.
Cognitive deficits as a mediator of poor occupational function in remitted major depressive disorder patients. Int J Psychiatry Clin Pract. Int J Neuropsychopharmacol. Can J Psychiatry.