한국형 우울장애 약물치료 알고리듬 2025 (V): 안전성, 부작용, 동반 신체질환을 고려한 항우울제 선택 및 치료저항성 우울증의 임상적 정의

Korean Medication Algorithm Project for Depressive Disorder 2025 (V): Antidepressant Choices According to Safety, Adverse Effect, Comorbid Physical Illnesses and Clinical Definition of Treatment Resistant Depression

Objectives This study developed expert consensus recommendations for antidepressant selection based on safety, adverse effects, comorbid physical illnesses, and the definition of treatment-resistant depression (TRD), as part of the Korean Medication Algorithm Project for Depressive Disorder 2025 (KMAP-DD 2025). Methods A national survey was conducted among 206 board-certified psychiatrists experienced in depression treatment. Using a 9-point Likert scale, the participants evaluated antidepressants across clinical scenarios, including adverse effect profiles, safety risks, comorbidities, and TRD definitions. The data were analyzed using the confidence intervals and chi-square tests. Results Bupropion and mirtazapine were frequently selected as first-line options for patients with sexual dysfunction, insomnia, or weight gain. Escitalopram and sertraline were preferred in cases with physical comorbidities, especially sertraline for cardiovascular conditions. TRD was most commonly defined (42.9%) as a nonresponse to two antidepressants and one atypical antipsychotic in combination therapy. The updated algorithm reflects a more individualized and safety-oriented approach than previous versions. Conclusion KMAP-DD 2025 provides practical, expert-driven guidance for antidepressant selection tailored to diverse patient needs. Compared to international guidelines (e.g., APA, NICE, and CANMAT), it emphasizes real-world relevance and local clinical priorities, offering valuable support for psychiatric practice in Korea. These findings highlight the importance of personalized treatment strategies and integrating consensus with emerging clinical evidence.