Table 7.

Treatment strategies for major depressive disorder in special populations

Special populations	Disorder	Severity of episode	Initial treatment strategies			AD			AAP or MS
			1st line	2nd line		1st line	2nd line		1st line	2nd line
Child and adolescent	Disruptive mood dysregulation disorder		-	AAP monotherapy AD ＋ AAP AD monotherapy MS ＋ AAPb MS monotherapy MS ＋ ADb		Escitalopram Fluoxetine	Sertraline Bupropion Duloxetine		Aripiprazolea Risperidone Valproate	Quetiapine Paliperidone Amisulpride Olanzapineb
	MDD	Mild-to-moderate episode, child	AD monotherapya	AD ＋ AAP AAP monotherapy AD ＋ AD AD ＋ MSb		Escitalopram Fluoxetine	Sertraline Bupropion Duloxetine Paroxetineb
		Mild to moderate episode, adolescent	AD monotherapy	AD ＋ AAP AAP monotherapy AD ＋ MS AD ＋ ADb		Escitaloprama Fluoxetine Sertraline	Venlafaxine Duloxetineb Bupropionb Paroxetineb Desvenlafaxineb Agomelatineb Vortioxetineb Mirtazapineb
		Non-psychotic severe episode, child	AD monotherapy AD ＋ AAP	AD ＋ AD AD ＋ MS AAP monotherapyb		Escitaloprama Fluoxetine Sertraline	Bupropion Paroxetineb Duloxetineb Venlafaxine Desvenlafaxineb			Aripiprazole Quetiapineb Risperidoneb
		Non-psychotic severe episode, adolescent	AD monotherapy AD ＋ AAP	AAP monotherapy AD ＋ MS AD ＋ ADb		Fluoxetinea Escitaloprama Sertraline	Bupropion Paroxetineb Venlafaxine Duloxetineb Desvenlafaxineb Agomelatineb Vortioxetineb			Aripiprazole Quetiapineb Risperidoneb
		Psychotic severe episode, child	AD ＋ AAPa	AAP monotherapy AD ＋ MS AD monotherapyb AD ＋ ADb		Escitalopram fluoxetine Sertraline	Bupropion Mirtazapine Paroxetineb Venlafaxineb Desvenlafaxineb Duloxetineb		Aripiprazolea Risperidone Quetiapine	Amisulpride Olanzapineb Paliperidoneb
		Psychotic severe episode, adolescent	AD ＋ AAPa	AAP monotherapy AD ＋ MS AD monotherapyb AD ＋ ADb		Escitaloprama Fluoxetine Sertraline	Paroxetineb Venlafaxine Duloxetineb Bupropionb Desvenlafaxineb Vortioxetineb Mirtazapineb		Aripiprazolea Risperidone	Quetiapine Amisulpride Olanzapineb Paliperidoneb
Elderly	MDD	Mild to moderate episode	AD monotherapya	AD ＋ AAP AD ＋ AD AAP monotherapy AD ＋ MS AD ＋ STM		Escitaloprama Sertraline Desvenlafaxine Vortioxetine Duloxetine Venlafaxine Fluoxetine Mirtazapine Milnacipran	Paroxetine Agomelatine Bupropion Tianeptine
		Non-psychotic severe episode	AD monotherapy AD＋AAP	AD ＋ AD AD ＋ MS AAP monotherapy AD ＋ STM		Escitaloprama Sertraline Desvenlafaxine Duloxetine Mirtazapine Vortioxetine Venlafaxine Fluoxetine Milnacipran Paroxetine	Agomelatine Bupropion Tianeptine Esketamine (nasal spray)b TCAs
		Psychotic severe episode	AD ＋ AAPa	AD monotherapy AD ＋ MS AD ＋ AD AD ＋ STM AAP monotherapyb		Escitaloprama Sertraline Desvenlafaxine Duloxetine Mirtazapine Venlafaxine Vortioxetine Fluoxetine Milnacipran Paroxetine	Agomelatine Bupropion Tianeptine Esketamine (nasal spray)b TCAs		Aripiprazolea Quetiapine	Olanzapine Risperidone Paliperidone Blonanserin Amisulpride Ziprasidone
Women	Premenstrual dysphoric disorder		AD monotherapya			Fluoxetine Escitalopram Sertraline Paroxetine Desvenlafaxine Venlafaxine	Duloxetine Vortioxetine Milnacipran Mirtazapine Agomelatine Bupropion Tianeptine TCA
	MDD in pregnancy	Mild to moderate episode	AD monotherapy	AAP monotherapy AD ＋ AAPb ECTb
		Non-psychotic severe episode	AD monotherapy	AD ＋ AAP AAP monotherapy ECT
		Psychotic severe episode	ECT AD ＋ AAP	AAP monotherapy AD monotherapy AAP ＋ MS
	Postpartum depression	Mild to moderate episode	AD monotherapy AD ＋ AAP	AAP monotherapy AD ＋ MS MS monotherapy MS ＋ AAPb ECTb
		Non-psychotic severe episode	AD ＋ AAP	AD monotherapy AAP monotherapy AD ＋ MS MS monotherapy AAP ＋ MS ECT
		Psychotic severe episode	AD ＋ AAPa	AD monotherapy AAP monotherapy AD ＋ MS MS monotherapy AAP ＋ MS ECT

AAP, atypical antipsychotics; AD, antidepressant; ECT, electroconvulsive therapy; MDD, major depressive disorder; MS, mood stabilizer; STM, psychostimulant; TAP, typical antipsychotics; TCA, tricyclic antidepressant.

^aTreatment of choice (TOC), defined as an option that was rated at 9 points by 50% or more of the experts. ^bNo consensus.