APA Updates Clinical Guidelines for Major Depressive Disorder

The American Psychiatric Association (APA) has released a new clinical practice guideline for the treatment of patients with major depressive disorder. The guideline provides an update to a previous version published 10 years ago and includes new evidence-based recommendations on the use of antidepressant medications, depression-focused psychotherapies, and somatic treatments such as electro-convulsive therapy.

The guideline addresses other topics as well, including alternative and complementary treatments, the treatment of depression during pregnancy, and strategies for treatment-resistant depression.

“The five-year process of intense review, discussion and thoughtful revision-making has led us to today’s release of new guidelines that we believe will improve patient care,” said Alan J. Gelenberg, MD, in a statement. “We are hopeful these guidelines will lead to improved lives for many patients.”

Gelenberg led a work group made up of APA members with extensive research and clinical expertise in the assessment and treatment of major depressive disorder that worked to update the guidelines. The group reviewed over 13,000 articles published from 1999, when the search from the previous edition ended, to 2006.

A few key changes to the guidelines include:

• Rating Scales: The guideline recommends potentially using a clinician- and/or patient-administered rating scale to assess the type, frequency, and magnitude of psychiatric symptoms in order to tailor the treatment plan to match the needs of the particular patient.
• New Strategies for Treatment-Resistant Depression: The guideline explains that electroconvulsive therapy has the strongest data supporting it as a treatment for patients who do not respond to multiple medication trials. Transcranial magnetic stimulation and vagus nerve stimulation have also been added as potential treatments for these patients. Monoamine oxidase inhibitors, known as MAOIs, are also an option.
• Exercise and Other Healthy Behaviors: The guideline cites randomized, controlled trials that demonstrate at least a modest improvement in mood symptoms for patients who engage in aerobic exercise or resistance training. Regular exercise may also reduce the prevalence of depressive symptoms in the general population, with specific benefit found in older adults and individuals with co-occurring medical problems.
• Maintenance Treatment Recommendation Strengthened: The guideline recommends that after the continuation phase, maintenance treatment should be considered, especially for patients with risk factors for recurrence. Maintenance treatment should definitely be provided for patients with more than three prior depressive episodes or chronic illness.

To access the guidelines, click here.

To read a Psychiatric Times editorial in which APA President Carol A. Bernstein, MD, discusses the review that was conducted to ensure the guideline was free of bias, click here.

Do you feel that the updated guidelines adequately address the most prevalent topics in the treatment of this patient group? What aspect of the updated guidelines will have the most potential impact on the way you practice?