한국형 우울장애 약물치료 알고리듬 2025 (I): 주요우울삽화의 치료전략

• Published in: Singyŏng chŏngsin ŭihak Vol. 64; no. 3; pp. 178 - 192
• Main Author: 최원석(Won-Seok Choi), 우영섭(Young Sup Woo), 박원명(Won-Myong Bahk), 김낙영(Nak-Young Kim), 박성용(Sung-Yong Park), 김원(Won Kim), 이정구(Jung Goo Lee), 양찬모(Chan-Mo Yang), 성형모(Hyung Mo Sung), 왕성민(Sheng-Min Wang), 정영은(Young-Eun Jung), 정종현(Jong-Hyun Jeong), 심세훈(Se-Hoon Shim), 민경준(Kyung Joon Min), 이상열(Sang-Yeol Lee), 전덕인(Duk-In Jon), 윤보현(Bo-Hyun Yoon), 김문두(Moon-Doo Kim), 서정석(Jeong Seok Seo)
• Format: Journal Article
• Language: Korean
• Published: 대한신경정신의학회 31.08.2025
• Subjects: 정신과학; Pharmacotherapy; 주요우울장애; 알고리듬; Algorithm; 약물치료; Major depressive disorder
• ISSN: 1015-4817; 2289-0963
• DOI: 10.4306/jknpa.2025.64.3.178

Objectives The Korean Medication Algorithm Project for Depressive Disorder 2025 (KMAP-DD 2025) was developed to provide updated, consensus-based pharmacological treatment guidelines for major depressive disorders in Korea, reflecting recent clinical evidence and domestic practice patterns. Methods Survey data for the KMAP-DD 2025 were collected through a structured expert consensus process based on the RAND/UCLA appropriateness method. A revised questionnaire was sent to 206 experienced Korean psychiatrists, and responses from 97 psychiatrists and 42 child/adolescent psychiatry specialists were analyzed to arrive at a consensus on pharmacological strategies for major depressive episodes (MDE). Results For mild-to-moderate MDE, antidepressant (AD) monotherapy was recommended as the treatment of choice (TOC), with combination therapies involving mood stabilizers or atypical antipsychotics (AAP) as secondary options. In severe non-psychotic episodes, AD monotherapy, AD plus AAP, and dual AD therapy were all first-line options, while for severe psychotic episodes, AD plus AAP was the TOC. Escitalopram was consistently preferred as the first-line AD, and aripiprazole and quetiapine as leading AAPs. If initial treatments failed, strategies included switching or augmenting with another AD, AAP, or augmentation agents such as lithium, which remained the preferred third-line option. Conclusion Compared to the previous editions, KMAP-DD 2025 showed an increased preference for early combination therapies, especially in more severe or psychotic depression, and a higher reliance on AAPs. These recommendations reflect the evolving clinical trends and the need for practical, context-specific guidance in Korean practice. KCI Citation Count: 0