Major Depressive Disorder Treatment Guidelines in America and Europe

ArticleinThe Journal of Clinical Psychiatry 71 Suppl E1(suppl E1):e04 · March 2010with641 Reads
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.
    • "Treatments for episodes of major depressive disorders usually last between 6 months and 1 year. Antipsychotics are required for severe depressions with psychotic symptoms until these symptoms are controlled [4]. More infrequently, drug combinations, electroconvulsive therapy, transcranial magnetic stimulation, vagus nerve stimulation, or deep brain stimulation, among other techniques, may be necessary in cases of treatment-refractory depression [5]. "
    [Show abstract] [Hide abstract] ABSTRACT: Mood is the overall affective quality that is based on how the individual experiences the world and themselves in a given time or period. It is the affective tone of this experience. Typically, the states of mood fluctuate according to internal or external, objective or subjective events within a certain range compatible with such events, and these oscillations are inherent to events. Therefore, mood swings can be considered normal. However, they can also occur for pathological reasons and represent a significant change in the functioning of the affected person. When mood swings are pathological, they lose the quantitative and qualitative proportionality in relation to the events that would have promoted them and are no longer explained by them. Furthermore, these oscillations can arise spontaneously, without association with any event; they can be durable and disruptive and can destabilize the individuals and their relationship with the world. Mood disorders can occur in several mental disorders but are more common in depressive and bipolar disorders.
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    • "Regardless, AS appears to limit multimodal outcome for youth with OCD and may partially explain why multimodal treatment for OCD is not consistently more advantageous than CBT-ERP alone (Foa et al., 2005; Ivarsson et al., 2015; Storch et al., 2013). Research seeking to better understand how AS impacts multimodal treatment outcome is needed, especially in other pediatric populations beyond OCD where multimodal treatment is common (e.g., Davidson et al., 2010; Walkup et al., 2008). Some have mentioned that starting multimodal treatments simultaneously versus sequentially may result in worse outcomes (Petersen, 2006); our results were observed despite the recommended sequential initiation of treatment. "
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    • "However, this review considered only peripheral or bloodbased biomarkers used in current clinical practice due to their comparative non-invasive nature and ease of measurement. The uncertainty surrounding management decisions in patients with depression in current practice is a particular issue at the time of initial presentation (Davidson, 2010). Hence, this review was focussed on addressing the issue of the use of peripheral biomarkers at baseline or pre-treatment as a predictive tool of clinical outcome (both mental and physical) and not on assessing changes in a peripheral biomarker level following treatment for depression. "
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