Gin S Malhi1,2,3, Erica Bell1,2,3, Ajeet B Singh4, Darryl Bassett5, Michael Berk6,7, Philip Boyce8,9, Richard Bryant10, Michael Gitlin11, Amber Hamilton1,2,3, Philip Hazell9, Malcolm Hopwood12, Bill Lyndon1, Roger S McIntyre13, Grace Morris1,2,3, Roger Mulder14, Richard Porter14, Lakshmi N Yatham15, Allan Young16,17, Greg Murray18. 1. Department of Psychiatry, Northern Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia. 2. Academic Department of Psychiatry, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, NSW, Australia. 3. CADE Clinic, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, NSW, Australia. 4. The Geelong Clinic Healthscope, IMPACT - Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Deakin University, Geelong, VIC, Australia. 5. Consultant Psychiatrist, Perth, WA, Australia. 6. IMPACT - the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Deakin University, Geelong, Australia. 7. Orygen, The National Centre of Excellence in Youth Mental Health, The Florey Institute and the Department of Psychiatry, The University of Melbourne, Parkville, Vic., Australia. 8. Department of Psychiatry, Westmead Hospital and the Westmead Clinical School, Wentworthville, NSW, Australia. 9. Discipline of Psychiatry, Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia. 10. School of Psychology, University of New South Wales, Sydney, NSW, Australia. 11. Department of Psychiatry, Geffen School of Medicine at UCLA, Los Angeles, CA, USA. 12. Department of Psychiatry, University of Melbourne and Professorial Psychiatry Unit, Albert Road Clinic, Melbourne, Vic., Australia. 13. Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada. 14. Department of Psychological Medicine, University of Otago, Christchurch, New Zealand. 15. Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada. 16. Department of Psychological Medicine, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK. 17. South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Beckenham, UK. 18. Centre for Mental Health, Swinburne University of Technology, Hawthorn, VIC, Australia.
Abstract
OBJECTIVES: To provide a succinct, clinically useful summary of the management of major depression, based on the 2020 Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for mood disorders (MDcpg2020 ). METHODS: To develop the MDcpg2020 , the mood disorders committee conducted an extensive review of the available literature to develop evidence-based recommendations (EBR) based on National Health and Medical Research Council (NHMRC) guidelines. In the MDcpg2020 , these recommendations sit alongside consensus-based recommendations (CBR) that were derived from extensive deliberations of the mood disorders committee, drawing on their expertise and clinical experience. This guideline summary is an abridged version that focuses on major depression. In collaboration with international experts in the field, it synthesises the key recommendations made in relation to the diagnosis and management of major depression. RESULTS: The depression summary provides a systematic approach to diagnosis, and a logical clinical framework for management. The latter begins with Actions, which include important strategies that should be implemented from the outset. These include lifestyle changes, psychoeducation and psychological interventions. The summary advocates the use of antidepressants in the management of depression as Choices and nominates seven medications that can be trialled as clinically indicated before moving to Alternatives for managing depression. Subsequent strategies regarding Medication include Increasing Dose, Augmenting and Switching (MIDAS). The summary also recommends the use of electroconvulsive therapy (ECT), and discusses how to approach non-response. CONCLUSIONS: The major depression summary provides up to date guidance regarding the management of major depressive disorder, as set out in the MDcpg2020 . The recommendations are informed by research evidence in conjunction with clinical expertise and experience. The summary is intended for use by psychiatrists, psychologists and primary care physicians, but will be of interest to all clinicians and carers involved in the management of patients with depressive disorders.
OBJECTIVES: To provide a succinct, clinically useful summary of the management of major depression, based on the 2020 Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for mood disorders (MDcpg2020 ). METHODS: To develop the MDcpg2020 , the mood disorders committee conducted an extensive review of the available literature to develop evidence-based recommendations (EBR) based on National Health and Medical Research Council (NHMRC) guidelines. In the MDcpg2020 , these recommendations sit alongside consensus-based recommendations (CBR) that were derived from extensive deliberations of the mood disorders committee, drawing on their expertise and clinical experience. This guideline summary is an abridged version that focuses on major depression. In collaboration with international experts in the field, it synthesises the key recommendations made in relation to the diagnosis and management of major depression. RESULTS: The depression summary provides a systematic approach to diagnosis, and a logical clinical framework for management. The latter begins with Actions, which include important strategies that should be implemented from the outset. These include lifestyle changes, psychoeducation and psychological interventions. The summary advocates the use of antidepressants in the management of depression as Choices and nominates seven medications that can be trialled as clinically indicated before moving to Alternatives for managing depression. Subsequent strategies regarding Medication include Increasing Dose, Augmenting and Switching (MIDAS). The summary also recommends the use of electroconvulsive therapy (ECT), and discusses how to approach non-response. CONCLUSIONS: The major depression summary provides up to date guidance regarding the management of major depressive disorder, as set out in the MDcpg2020 . The recommendations are informed by research evidence in conjunction with clinical expertise and experience. The summary is intended for use by psychiatrists, psychologists and primary care physicians, but will be of interest to all clinicians and carers involved in the management of patients with depressive disorders.
Authors: Gin S Malhi; Mustafa Acar; Mahsa H Kouhkamari; Tzu Hsiang Chien; Prabhjot Juneja; Sinthuja Siva; Bernhard T Baune Journal: BJPsych Open Date: 2022-06-30