Evidence-Based Korean Pharmacological Treatment Guideline for Depression, Revised Edition (I) : Initial Choice of Antidepressant Treatment

Abstract

ObjectivesZZThe aim of this study is to establish Korean pharmacological treatment guidelines for the initial choice of antidepressant for treatment of moderate or severe depression.MethodsZZThe process for establishment of guidelines involved determination of important key questions, selection of 12 international and domestic clinical practice guidelines for depression, drawing of recommendation drafts, and peer review.ResultsZZSelective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), norepinephrine-dopamine reuptake inhibitors (NDRI), and noradrenergic and specific serotonergic antidepressants (NaSSA) were strongly recommended as the first−line antidepressants for treatment of moderate or severe depression. SSRIs were weakly recommended for patients who had problems with tolerability. Consideration of not only efficacy but also provisional adverse effects, drug-drug interactions, history of treatment response, preference, acceptonline © ML Comm

High Prevalence of Depression Diagnosis Among Medical Aid Beneficiaries: A Korean Health Insurance Database Study

“…Since, the 2015 claims database does not provide the tools that the physicians can use to make a diagnosis, we assumed that they used similar diagnostic tools to make a depression diagnosis regardless of the type of health coverage. 8,9 The prevalence of depression diagnosis was calculated as the proportion of outpatients diagnosed with depression, analyzed based on age group (0-19, 20-44, 45-64, 65-84, and ≥85 years), sex, area (rural and urban), type of health care coverage (health insurance and Medical Aid), type of medical institution (primary, secondary, tertiary, and public), and comorbidities. The type of medical institution was defined based on the number of beds and funding source (primary, 0-29 beds; secondary, 30-99 beds; tertiary, ≥100 beds; and public, publicly funded institution).…”

“…Since, the 2015 claims database does not provide the tools that the physicians can use to make a diagnosis, we assumed that they used similar diagnostic tools to make a depression diagnosis regardless of the type of health coverage. 8,9…”

Evidence-Based, Non-Pharmacological Treatment Guideline for Depression in Korea

“…By 2005, the Ministry of Health and Welfare, Republic of Korea Government took note of depression as a serious public health issue and considered a clinical practice guideline for depression to be essential to improve and organize its treatment or management. Eventually, the Ministry founded the Clinical Research Center for Depression as a project to develop the infrastructure of public mental health and medical management for depression ( 7 ). The Clinical Research Center for Depression aimed to identify the natural history of disease through clinical studies in Korean adults with depression and made a Korean version of an evidence-based treatment guideline for depression.…”

“…Hence, the Development Group of the Standardized Treatment Guideline for Depression of the Clinical Research Center for Depression, assigned by the Ministry of Health and Welfare, hoped that the present guideline would promote non-pharmacological approaches to provide alternative or adjuvant therapeutic mode of depression. Since relatively more severe depression essentially requires pharmacological treatment, pharmacological guidelines focus on patients with moderate or severe depression ( 7 ). However, according to severity classification of major depressive disorder of the DSM-IV ( 9 ), relatively less severe depression can be managed through non-pharmacological approaches.…”

Evidence-Based, Pharmacological Treatment Guideline for Depression in Korea, Revised Edition

“…Due to the limitations of the initial pharmacological treatment guideline, the accumulation of new clinical information with time, and the emphasis on the importance of a guideline reflecting the current local clinical situation, the "Evidence-Based, Pharmacological Treatment Guideline for Depression in Korea, Revised Edition" was released in 2012 ( 5 ). In an attempt to inform Korean practitioners of the recommendations made in the revised edition, papers reporting certain recommendations of the guideline were published in the Korean language ( 6 , 7 , 8 ). However, an introduction to the guideline as a whole has not yet been made, and no report on the guideline has ever been written in English.…”