Korean Medication Algorithm Project for Depressive ...

1 2012.. 2012.. 2012.. Korean Medication Algorithm Project for Depressive Disorder . kmap -DD. 2012. , .. 2012.. , .. ---------------------------------------- ---------------------------------------- -------------------------------- 005. ---------------------------------------- ------------------- 007. 2012 ---------------------------------------- --------------------- 008. I. ---------------------------------------- ---------------------------------------- ----------------------------- 009. II. ---------------------------------------- ---------------------------------------- ----------------------------- 010. III. ---------------------------------------- ---------------------------------------- ------------------------ 014. IV. ---------------------------------------- ---------------------------------------- ------------------------------ 020. V. ---------------------------------------- ---------------------------------------- ------------------------------ 025.

2 VI. ---------------------------------------- ---------------------------------------- ----------- 026. VII. ---------------------------------------- ---------------------------------------- ---------- 027. ---------------------------------------- ---------------------------------------- ----- 029. A. ---------------------------------------- ------------------ 030. B. ---------------------------------------- -------------------------- 038. C. / ---------------------------------------- ---------------------------------------- ---- 045. D. ---------------------------------------- ----- 048. E. , , , ---------------------------------------- ------------------------- 051. F. ---------------------------------------- ---------------------------------- 058. G. ---------------------------------------- ------------------------------------- 060. VIII. ---------------------------------------- ---------------------------------------- ---------------------------- 063.

3 IX. ---------------------------------------- ---------------------------------------- ---------------------------- 108. 3.. 2002 ( ), , .. 2002 2006 .. 4 . 1 . , .. 2006 .. , .. , .. , .. , .. 1 .. 5. kmap -DD.. 2012 . , 2012 .. , , .. 2016 . , .. 2012 .. 6 .. ( Korean Medication Algorithm Project for Depressive Disorder, K- MAP-DD 2012) 2006 .. 1.. , , .. ' ' .. ' , ' . 2.. , .. 3.. 4.. kmap -DD 7. kmap -DD. 2012 . : ( ) : ( ). ( ). ( ) ( ). ( ) ( ). ( ) ( ). ( ) ( ). ( ) ( ). ( ). 8 2012 .. I.. 1950 1980 .. , , . , , ( ) . , .. , , .. 2002 , 2006 .. 6 , . 2012 .. 2012 2006 . , .. 2012 .. 9. kmap -DD. II.. 1.. 1) . 2012 2006 . 2006 . 2012 , ECT TMS, VNS .. 2006 2002 , .. 2006 RAND Corporation 9 .. 123 , 67 ( ) .. 2- ( 2 test) (non-randomdistribution) .. 95% (confidence interval, CI) 1. / (first-line/preferred choice), 2 / (secondline/alternate choice), 3 (third choice) 3.

4 (guideline table) .. , .. ( kmap -DD). 2012 . 2) . 2006 . , . , 2 .. , , . (ECT) 2006 . , , , , , .. 10 .. 3) . 9 .. , . 1 . 1. : . , .. = : treatment of choice . - = : . - = : . ( , , . , ). - = : . = : . = . 1.. 4) . 123 .. 90 , 23 , . 10 , 67 ( ) .. 5) . 3 ( - , - , - ) 2- .. 95% .. 1 , 2 . 1 . 11. kmap -DD. , . 2 . 3 . 1 50% . 9 (treatment of choice)' . 6) . 2 . 95% (Confi- dence interval, CI) , 2 .. (63 ) . 95% 1st 2nd 3rd 3rd Line 2nd Line 1st Line Line Line Line * ( ) + ( ) + ( ) ( ) ( ) + ( ) ( ) ( ) 1 2 3 4 5 6 7 8 9 % % %. 2.. 7) . SSRI . TCA .. 8) (The Ratings). (1) 1 (first-line treatment) ' .. (Treatment of choice) * ' 1 . 9' . 12 .. (2) 2 (Second-line treatment) 1 .. 1 ( , . , , , , . , 1 ) .. 3 , .. 1 2 , 1.. (3) (Non-consensus). 2- . 3 2 . ' ' .. 2.. , .. 1 ( , pre- ferred options) 2 (alternative options) 2 . 1 1 .. (guideline table).

5 13. kmap -DD. III.. 63 .. 28 62 .. 26 . 2012 . 1.. 1) . 1 , . 1 . fluvoxamine SSRI milnacipran . SNRI , mirtazapine 1 . fluvoxamine fluoxetine . SSRI milnacipran SNRI , mirtazapine 1 . TCA . bupropion 2 .. 1 .. , lithium, buspirone, pin- dolol, psychostimulant, thyroid hormone(T3) . 2) . 1 .. , 2 .. 3 . 2 3 . , , .. , .. , .. mirtazapine, (es)citalopram, venlafaxine, paroxetine, sertraline, duloxetine, fluoxetine . quetiapine, aripiprazole, olan- zapine, risperidone 1 amisulpride, ziprasidone, blonanserine, lodopine, . , clozapine 2 . 14 .. 1.. 1 2 . * + . + . + . + .. + * + .. + .. * : . 2.. 1) . 1 , fluvoxamine SSRI. [(es)citalopram, fluoxetine, sertraline, paroxetine], SNRI, mirtazapine 1 . 2) . fluvoxamine SSRI[(Es)citalopram, fluoxetine, sertraline, parox- etine], SNRI, mirtazapine 1 , 2 TCA, fluvoxamine, bupropion, tianeptine, moclo- bemide.

6 , . 2 bupropion 1 . 3) (Minor Depressive disorder). 67% 33% . 77%.. 3.. , ( ), .. 2 . ( ), . 3 . 15. kmap -DD. ( ).. ( ), , .. ( ), . , . 3 . ( ). , 2 . , 3 . 75% . , 50% 2 . 4. Special population . 1) . 1 .. 2) . 1 , . 1 .. , 1 (es)ci- talopram, sertraline, paroxetine, SNRI, mirtazapine , 2 TCA, fluoxetine, fluvoxamine, bupro- pion, tianeptine, moclobemide . 3) . 1 , 2 . , , ( , , , NSAIDS, , . ) . 1 (es)citalopram, fluoxetine, paroxetine, sertraline, duloxetine, venlafaxine . 1 , . , , , . estrogen , 2 . , . 1 . 16 .. 2. Special population . 1 2 . + .. + .. + . + .. + * .. + . + .. * + . + .. + . + .. + * .. + . + .. + .. + .. +estrogen . + . + .. +estrogen . + * . + .. +estrogen * : , : No consensus 17. kmap -DD. 5.. 1) . bupropion 1 , mirtazapine 2 .. bupropion 1 , (es)citalopram flu- oxetine 2 . bupropion-fluoxetine-(es)citalopram , . mirtazapine-trazodone-paroxetine.

7 ( / ) . mirtazapine . (es)citalopram-bupropion-sertraline . 2) . , , , (es)citalopram , . bupropion , mirtazapine . 3) . , , (es)citalopram , 2 se- rtaline . 6.. 1) (ECT).. ECT , (38/45) ECT .. 46%(28/50) , ECT 53%(28/53) .. ECT 1 , 1 1 3 10 .. 2) (TMS). TMS 1 , . , . 2 . (33/42) TMS . 76%. (35/46) , TMS 32%(14/44) . 18 .. 3) . , 3 , , (VNS), . (DBS) 2 . 19. kmap -DD.. 1.. 1) .. 2006 . , , .. 1 , . 1 . 2/3 . kmap -DD 2012 . 2 .. (CANMAT), 2009 . STRA*D , .. 2 3 . , lithium, buspirone, pindolol, thyroid hormone(T3) . 2006 .. aripiprazole quetiapine . , .. 2) . , .. , (residual symptom subthreshold depres- sion) .. ( ) . ( ), . 2 ( . ) , . 3 .. ( ) . , , .. 20 .. ( ) , . , . 3 . ( ). 2007 World Federation of Societies of Biological Psychiatry(WFSBP) . , 3 .. CANMAT(2009) 6 5 .. , , .. CANMAT(2009) , . 75% 1 , . 50% 2 . 2.. 3 7 2006 3~6 .. 2~5 , 3~7.

8 , 2006 , . CANMAT(2009) 1~2 , . 1~2 , 2 . 20% .. STRA*D citalopram 8 56% .. 2~4 , 20% . 3~7 . 3. : , . , . , .. fluvoxamine SSRI milnacipran SNRI . , mirtazapine 1 . 2006 .. 1 , mirtazapine .. TCA MAOI 2 . , 2 1 . 21. kmap -DD.. quetiapine, aripiprazole, olanzapine, ri- speridone 1 amisulpride, ziprasidone, blonanserine, lodopine, , clozapine 2 .. , , . bupropion , mirtazapine .. (es)citalopram . , , , . (es)citalopram , bupropion , mirtaza- pine .. 4.. 1 . , . , fluvoxamine SSRI[(es)citalopram, fluoxetine, ser- traline, paroxetine], SNRI, mirtazapine . 1 bupropion . (minor Depressive disorder) 67% . 33% . 77% .. 5. Special population . 2006 . 1) .. , . 1 .. 2) .. , .. 1 , . 1 .. 22 .. SSRI mirtazapine , , . fluvoxamine SSRI SNRI, mirtazapine 1 . 3) . 1 , (Es)citalopram, fluoxetine, paroxetine, sertraline, duloxetine, venlafaxine . 1 , . , 1.

9 CAN- MAT(2009) . citalopram, nortriptyline, sertraline, paroxetine . SSRI , . 6.. (ECT) 53% 2006 50% . (TMS) , 3 , , (VNS), . (DBS) . 7. kmap -DD 2012 .. , . 1 .. 2012 .. , , , , , .. , .. , , .. 23. kmap -DD.. special population .. , , .. 24 .. V.. 1 .. , . , .. , .. 25. kmap -DD. VI.. 26 . 2012. VII.. A.. 1 : [1 ] . 2 : [2 ] . 3 : [3 ] 2 . B.. 4 : [1 ] . 5 : [2 ] . 6 : [3 ] 2 . C. / . 7 : / : . D.. 8 : (dysthymic disorder) : . 9 : . E. , , , . 10 : . 11 : . 12 : . F.. 13 : . 14 : . G.. 15 : (ECT). 16 : (TMS) . 17 : (complementary) (novel) . 29. kmap -DD. A.. 1 : [1 ] .. 1) .. 1 .. 1 . + . + 2 . , . 2 .. 1 2 . * + . + . + . + .. 1, 2. * : . kmap -DD 2006 . 2006 .. 1 . 2 , + . + . 2006 + 2 . 2012 . 2 .. 2) . fluvoxamine SSRI milnacipran SNRI , mirtazapine 1 . fluvoxamine fluoxetine . SSRI milnacipran SNRI , mirtazapine 1 . TCA. 30 .. bupropion 2.

10 SSRI fluvoxamine . 2 , 1 fluoxetine . 2 . SNRI milnacipran 1 . 2 . 1 2 . (Es)citalopram Bupropion Sertraline Fluvoxamine Paroxetine Tianeptine Duloxetine Moclobemide Mirtazapine Agomelatine Venlafaxine Amitriptyline Fluoxetine Nortriptyline Milnacipran Trazodone Imipramine Clomipramine Venlafaxine Fluoxetine Mirtazapine Milnacipran (Es)citalopram Bupropion Paroxetine Fluvoxamine Sertraline Moclobemide Duloxetine Agomelatine Imipramine Nortriptyline Tianeptine Clomipramine Trazodone 3. : . kmap -DD 2006 . SSRI venlafaxine, mirtazapine SSRI . fluvoxamine, fluoxetine . 2006 . SSRI citalopram( ), paroxetine( ), sertraline( ), fluoxetine( ), fluvoxamine( ) . Milnacipran 2006 2 . 2012 1 . 2006 duloxetine . , 1 .. 3) 1 .. , . ( 4). 31. kmap -DD. kmap -DD 2006 . 2006 , . , , .. 2 : [2 ] . 1) 2 .. 1 .. , lithium, buspirone, pindolol, psychosti- mulant, thyroid hormone(T3).