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Tryptophan and Brain Disorders / Treatment of Major Depression · Journal article
The International Journal of Neuropsychopharmacology · September 1, 2026
A consensus or society position rather than new primary data.
This is a revised expert consensus algorithm for pharmacological treatment of pediatric major depressive disorder and disruptive mood dysregulation disorder, synthesizing research and clinical experience through structured expert survey. It recommends antidepressant monotherapy as first-line for mild-to-moderate MDD, and combination therapy with atypical antipsychotics for severe or psychotic depression in children and adolescents.
Expert consensus survey. Expert panel of child and adolescent psychiatrists in Korea; no patient population studied directly. Intervention: Systematic expert solicitation and consensus-building regarding antidepressant monotherapy, antidepressant augmentation with atypical antipsychotics, and treatment stratification by severity and psychotic features. n = 42. Korea.
Antidepressant monotherapy recommended as first-line for mild-to-moderate MDD in children and adolescents Both AD monotherapy and AD augmentation with atypical antipsychotics recommended as first-line for severe MDD without psychotic features AD augmentation with atypical antipsychotics preferred as first-line for MDD with psychotic features
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Clinicians can use this algorithm to guide first-line medication selection in pediatric depression based on severity and psychotic features. The differentiated approach across depression subtypes and severity levels provides actionable guidance for initial treatment planning.
Expert consensus-based treatment algorithm for pediatric depression, systematically revised through iterative survey methodology, providing actionable clinical recommendations without new primary efficacy data.
As stated by the source record.
Quoted from the source exactly as published.
Clinicians can use this algorithm to guide first-line medication selection in pediatric depression based on severity and psychotic features. The differentiated approach across depression subtypes and severity levels provides actionable guidance for initial treatment planning.
Graded across the dimensions that decide whether you should act, each from what the source actually supports. There is no single score, and where a dimension was not assessed it says so.
Abstract Background In Korea, the Korean Medication Algorithm for Major Depressive Disorder, based on expert consensus on depression medication, was first published in 2002. Afterwards, based on new research results and accumulated clinical experience, the first revised edition, the Korean Medication Algorithm for Depressive Disorders 2006, was published in 2006. In 2012, the second revision, KMAP-DD 2012, was published. In particular, drug treatment for major depressive disorder in children and adolescents was first investigated in KMAP-DD 2012, and in KMAP-DD 2017, treatment strategies for disruptive mood dysregulation disorder, a new category in DSM-5, were added. In KMAP-DD 2021, treatment strategies for children and adolescents were distinguished, and differentiated approaches for DMDD treatment according to gender were presented. Subsequently, in the revised KMAP-DD 2025, more sophisticated and specific treatment strategies for major depressive disorder and DMDD in children and adolescents were established by reflecting the latest research results accumulated over the past four years and the actual experiences of domestic clinical experts. Aims & Objectives The Korean Medication Algorithm Project for Depressive Disorder 2025 (KMAP-DD 2025) represents a revision of the prior iterations. The primary objective of the present study was to refine treatment guidelines for major depressive disorders (MDDs) in child and adolescent populations. Method The survey instrument comprised 21 questionnaires specifically tailored for children and adolescents. A total of 42 out of 70 experts in child and adolescent psychiatry completed and returned the survey questionnaires. Results Antidepressant (AD) monotherapy was identified as the first-line treatment option for major depressive disorder (MDD) of mild-to-moderate severity. For severe MDD without psychotic features in children and adolescents, both AD monotherapy and AD augmentation with atypical antipsychotics (AAPs) were recommended as first-line treatments. In cases of MDD with psychotic features, AD augmentation with AAPs was the preferred first-line treatment strategy. Discussion & Conclusions We have developed a treatment algorithm specifically for child and adolescent populations with depressive disorders, offering enhanced specificity compared to the KMAP-DD 2021. It is anticipated that this algorithm will furnish clinicians with valuable information and facilitate the management of depressive disorders in children and adolescents.
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