Table 3.
Comparisons of recommendations for treatment of major depressive disorder with poor response to initial treatment across practice guidelines
| Treatment step | Response | KMAP-DD 2021 | WFSBP 2013 | BAP 2015 | CANMAT 2016 | RANZCP 2020 |
|---|---|---|---|---|---|---|
| MDE, insufficient response to initial treatment | Non-response | Switching AD, adding AD/AAP, switching AAP (if applied in previous step) | Switching AD (to different or same class when intole-rance); AD combination; augmentation with lithium, quetiapine, aripiprazole | Switching AD (either within or between AD class) | Switching AD | Augmentation (lithium, aripiprazole) |
| Partial response | Adding AD/AAP, switching AAP (if applied in previous step) | Adding quetiapine, aripipra-zole, or lithium | Adding AAP | |||
| Third step or treatment resistance | For MDE without psychotic features: combination of 2 ADs, augmentation with AAP, combination of 2 ADs and 1 AAP, augmentation with both AAP and other augmenting agents (lithium, valproate, lamotrigine, carbamazepine, buspirone, thyroid hormone, or psychostimulants) | Augmentation (lithium, quetiapine, aripiprazole), switching AD with the potential for superior efficacy (venlafaxine, escitalopram, tranylcypromine) | Consider a different AD class after more than one failure with a specific class; Consider venlafaxine after more than one SSRI failure and addition of AD, AAP, or augmenting agent (tri-iodothyronine, lithium) when AD switching has been unsuccessful | After failure of 1 or more ADs, consider switch to a second- line or third-line Ads; For early treatment resistance, consider adjunctive use of psychological and neuro-stimulation treatments | Switching (after aug-mentation) within classes: intolerability ofdifferent classes: lack of efficacy |
AAP, atypical antipsychotics; AD, antidepressant; BAP, British Association for Psychopharmacology Guidelines; CANMAT, Canadian Network for Mood and Anxiety Treatments Clinical Guidelines for the Management of Major Depressive Disorders; MDE, major depressive episode; RANZCP, Royal Australian and New Zealand College of Psychiatrists Clinical Practice Guidelines for Mood Disorders: Major Depression; WFSBP, World Federation of Societies of Biological Psychiatry Guidelines for Biological Treatment of Unipolar Depressive Disorders (WFSBP); KMAP-DD, Korean Medication Algorithm Project for Depressive Disorder.