Major Depressive Disorder Treatment Guidelines in America and Europe

Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, USA.
The Journal of Clinical Psychiatry (Impact Factor: 5.5). 03/2010; 71 Suppl E1(suppl E1):e04. DOI: 10.4088/JCP.9058se1c.04gry
Source: PubMed


The various major American and European guidelines for the treatment of depression provide similar basic principles of treatment, which include individualizing the treatment plan, preparing the patient for potential long-term treatment, providing measurement-based care, and treating to remission. While the guidelines are all evidence-based, certain factors can influence differences in specific recommendations, such as the consensus group's composition, underlying mandates, and cultural attitudes. The similarities and differences among 6 sets of guidelines from Europe and the Americas published in the past decade are reviewed here (American Psychiatric Association, British Association for Psychopharmacology, Canadian Network for Mood and Anxiety Treatments, National Institute for Health and Clinical Excellence, Texas Medication Algorithm Project, and World Federation of Societies of Biological Psychiatry). In the guidelines, mild depression has the most variance in treatment recommendations; some, but not all, guidelines suggest that it may resolve with exercise or watchful waiting, but psychotherapy or antidepressants could be used if initial efforts fail. Moderate and severe major depression carry broadly similar recommendations among the guidelines. First-line treatment recommendations for moderate major depressive disorder include antidepressant monotherapy, psychotherapy, and the combination of both. Severe depression may require the combination of an antidepressant and an antipsychotic, electroconvulsive therapy, or the combination of an antidepressant and psychotherapy. Benzodiazepines play a very limited role in the treatment of depression; if the patient has catatonic depression, acutely suicidal depression, or depression with symptoms of anxiety, agitation, or insomnia, benzodiazepines are recommended by some guidelines for short-term treatment only.

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    • "Depression is one of the most common mental disorders in current Western societies. At present, it continues to grow in numbers and is one of the main causes of disability around the world, particularly in high-income regions (e.g., Davidson, 2010; McKenna, Michaud, Murray, & Marks, 2005; World Health Organization [WHO], 2005). To deal with this relevant health and social problem, there are several efficient interventions such as use of antidepressant drugs (ADs; Geddes et al., 2003; Perestelo-Pérez et al., 2010) and psychological treatments, particularly those derived from a cognitive-behavioural approach (Aguilera, Garza, & Muñoz, 2010; Kaltenthaler et al., 2006; Merry, McDowell, Hetrick, Bir, & Muller, 2004). "
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    • "@BULLETMood (Cools et al., 2008; Davidson, 2010) @BULLETBipolar disorder, MDD, and schizophrenia (Millan, 2000; Miklowitz & Johnson, 2006; Engleman et al., 2008; Savitz et al., 2009) "
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    • "Many groups have previously found that use of antipsychotic medication is a likely risk factor for MetS, obesity and diabetes in schizophrenia (Smith et al. 2008) and bipolar disorder (Vancampfort et al. 2013). Adjunctive treatment with antipsychotic medications has been endorsed for treatment-resistant depression by several clinical practice guidelines (Davidson, 2010) and was supported by a recent meta-analysis (Farahani & Correll, 2012). It is also clear that different antipsychotics differ in their cardiometabolic risk profile (Correll et al. 2011; De Hert et al. 2011c). "
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