Background and Purpose
Depression is the most common and serious problem-causing mental disorders. According to the World Health Organization (WHO), more than 264 million people worldwide complained of depression in 2017, an increase of 50% compared to 1990. According to the 2019 Global Burden of Disease Study, the disease burden of depression was ranked 13th among the top 25 diseases, with similar AIDS, liver cirrhosis, lung cancer, headache, and disease burdens. In the 2016 World Mental Health Survey, depression had the greatest disease burden (The disability-adjusted life year; DALY) among mental disorders. In a 2021 epidemiologic survey of mental health in Korea, the lifetime and 1 year prevalence of major depressive disorder were 7.7% and 1.7% which were similar to that of anxiety disorder and nicotine use disorder. In particular, the lifetime prevalence of females was 2.2 times higher than that of males, and it was the highest at 3.1% in the elderly over 70 years. According to the 2021 cause of death statistics by Korea National Statistical Office, suicide ranked 5th, higher than diabetes and Alzheimer’s disease. In particular, suicide ranked 1st in the cause of death in the teenage suicide, In the standardized suicide rate, Korea was the highest among 38 OECD member countries. Depression is a major cause of suicide. In the field of ‘reinforcement of chronic disease prevention and management’ of national public health management, the problem of addiction such as smoking and drinking is a top priority. Addiction is closely related to depression. Moreover, chronic diseases such as cancer, heart disease, and stroke are often accompanied by depression. Depression has negative effects on suicide, dementia, cardiovascular disease, stroke, etc., and further increases medical and social costs. Therefore, management of depression is very important in national health management.
The main treatment options for depression are drug therapy, such as antidepressants, and non-pharmacological therapy, such as cognitive behavioral therapy. Although antidepressants are the most commonly used treatment for depression, they have several limitations such as a variety of side effects and treatment-resistant depression. And it is difficult to use cognitive behavioral therapy for depression because it takes a lot of time and money, and there is a shortage of skilled practitioners who can perform the treatment and the low accessibility. Therefore, there is high interest in Complementary and Integrative Medicine such as herbal medicine, acupuncture, and mind-body intervention to find effective treatments with fewer side effects that supplement the limitations of existing depression treatments.
Clinical guidelines using herbal medicine, acupuncture, and mind-body intervention are being developed in China, Japan, and Korea. In Korea, the Korean Medical Research Institute developed a clinical treatment guideline for depression in Korean Medicine in cooperation with the Korean Society of Oriental Neuropsychiatry in 2016.
In the 4th Comprehensive Plan for Promotion and Development of Korean Medicine (2021-2025), the main contents of ‘Improvement of oriental medical service system’ are ‘Strengthening reliability through the development of standard oriental clinical treatment guidelines’, and ‘Standardization of Korean Medicine through the spread of standard oriental clinical treatment guidelines’. This is the government’s plan to develop and disseminate standard clinical treatment guidelines for oriental medicine, strengthen the evidence, and through this, strengthen the health insurance coverage for oriental medical services to the public, thereby increasing access, while fostering the Korean Medicine industry in this process and strengthening international competitiveness. It reflects the will of Korean Medicine development policy. The ‘Korean Medicine Innovation Technology Development Project’, a national research and development project in the field of Korean medicine by the Ministry of Health and Welfare, started in 2020, and is supporting the development of standard clinical treatment guidelines for Korean Medicine through the guideline development project.
It has been 6 years since the existing depression treatment guidelines were developed, so it is urgent to reflect the latest evidence, and it was not described in accordance with the standardized format developed in 2018. In addition, clinical research results reflecting the domestic clinical reality were not reflected. Accordingly, our development group collected and analyzed evidence through an evidence-based medical methodology for Korean medicine treatment of depression, and revised the previous guidelines for depression by reflecting the results of domestic clinical studies.
This clinical treatment guideline aims to help the decision-making of clinical Korean medicine doctors and their patients and to improve national health and the quality of life by providing more effective and standardized treatment to patients with depression through the dissemination of the clinical treatment guidelines. Furthermore, it aims to contribute to improving public trust in Korean medicine and promoting national health by improving the quality of Korean medical treatment.
Overview of disease
Depression is characterized by a sad, empty, or irritable mood, accompanied by physical and cognitive changes that affect an individual’s ability to function. It causes clinically significant pain or disability in social, occupational, and other important areas of functioning. Major depressive disorder is characterized by a depressed mood or decreased interest and pleasure in activities for 2 weeks or more and 4 or more other symptoms of depression, including sleep, appetite, fatigue, concentration, and suicidal ideation. This clinical practice guideline is for adult patients diagnosed with major depressive disorder as they have clinically significant depressive symptoms classified in the Diagnostic and Statistical Manual of Mental Disorders (DSM)-IV or DSM-5. This guideline also includes depressive disorders accompanying old age, menopause and prenatal/postpartum.
