The present investigation redrafted the Korean Medication Algorithm Project for Depressive Disorder 2017 (KMAPDD 2017) guidelines by revising antidepressant choices based on their safety, side effects, comorbidity, and the clinical definition of treatment-resistant depression (TRD). 

It developed a 33-item questionnaire comprising six parts; and obtained a 65-expert consensus (67.0%) on pharmacological treatment strategies regarding antidepressant choice concerning safety, adverse effects, and comorbid physical illnesses. 

The results showed the first-line pharmacotherapeutic strategies based on various clinical considerations:

• Mirtazapine (for patients with increased suicidal tendency, Gastrointestinal distress, and insomnia), 
• Bupropion (for patients with orthostatic hypotension, prior safety accident, serotonin syndrome, sedation, sexual dysfunction, and increase in weight), 
• Escitalopram (for patients with anticholinergic side effects). 

The results also showed the first-line pharmacotherapeutic strategies for patients with comorbid conditions:

• Duloxetine for chronic pain, 
• Escitalopram for diabetes, hypertension, liver/renal/thyroid disease, Parkinsons disease, and epilepsy,
• Sertraline for arrhythmia and cardiovascular disease. 

This study demonstrates the Pharmacological treatment strategy for various subsets of patients with depression. Additional study is needed to determine antidepressant choices for Treatment-Resistant Depression and cancer patients with depression.

Journal of Korean Neuropsychiatric Association.2021: 267-274.