한국형 우울장애 약물치료 알고리듬 2025 (IV): 여성 및 노인

Korean Medication Algorithm Project for Depressive Disorder 2025 (IV): Female and Elderly

Objectives Depressive disorders vary widely by age and sex, necessitating individualized treatment approaches. Women experience hormonal fluctuations across their lifespan, contributing to distinctive symptom patterns, while older adults often present with atypical features such as cognitive decline or somatic complaints. With the rising prevalence of depression in Korea, the Korean Medication Algorithm Project for Depressive Disorder (KMAP-DD) has been periodically revised to offer practical, consensus-based treatment guidelines tailored to local clinical settings. Methods KMAP-DD 2025 involved a nationwide expert survey of 136 psychiatrists, and 97 responses were received (71.3% response rate). The questionnaire was based on previous editions and modified to reflect recent clinical developments. A 9-point modified RAND scale was used to rate the appropriateness of each treatment. Recommendations were categorized into first-, second-, or third-line options based on confidence interval thresholds and chi-square analyses. Results First-line treatments for premenstrual dysphoric disorder included selective serotonin reuptake inhibitors and desvenlafaxine. During pregnancy, antidepressant monotherapy and repetitive transcranial magnetic stimulation (rTMS) were recommended for non-psychotic depression, while antidepressant–antipsychotic combinations and electroconvulsive therapy were favored for psychotic cases. Postpartum depression strategies depended on symptom severity and psychotic features. In older adults, antidepressant monotherapy remained the first-line treatment for mild-to-moderate episodes; combination with antipsychotics was preferred in psychotic depression. Escitalopram was consistently the top-rated antidepressant across groups. Conclusion KMAP-DD 2025 maintains core treatment recommendations while incorporating emerging interventions such as rTMS. These updated guidelines underscore the importance of personalized and safe treatment strategies for depression in women and older adults.