ACP Creates Living Guideline for Interventions During Acute Phase of Major Depression

American College of Physicians recommends monotherapy with cognitive therapy or second-generation antidepressant for patients in acute phase of moderate-to-severe depression

By Elana Gotkine HealthDay Reporter

THURSDAY, Jan. 26, 2023 (HealthDay News) — In a living clinical guideline issued by the American College of Physicians (ACP) and published online Jan. 24 in the Annals of Internal Medicine, recommendations are presented for interventions during the acute phase of a major depressive disorder (MDD) episode.

Amir Qaseem, M.D., Ph.D., from ACP in Philadelphia, and colleagues presented updated clinical recommendations on nonpharmacologic and pharmacologic interventions as initial and second-line treatments during the acute phase of an MDD episode.

For initial treatment of patients in the acute phase of moderate-to-severe MDD, ACP recommends monotherapy with cognitive behavioral therapy or a second-generation antidepressant (strong recommendation; moderate-certainty evidence). For patients in the acute phase of moderate-to-severe MDD, ACP suggests combination therapy with cognitive behavioral therapy and a second-generation antidepressant as initial therapy (conditional recommendation; low-certainty evidence). Informed decisions relating to these options should be personalized. For patients in the acute phase of mild MDD, monotherapy with cognitive behavioral therapy is suggested as initial treatment (conditional recommendation; low-certainty evidence). For adults in the acute phase of moderate-to-severe MDD who did not respond to initial therapy with an adequate dose of a second-generation antidepressant, ACP suggests switching to or augmenting with cognitive behavioral therapy or switching to a different second-generation antidepressant or augmenting with a second pharmacologic treatment (conditional recommendations; low-certainty evidence). The informed decisions on these options should also be personalized.

“The ACP’s depression guideline is a step in the right direction to improving primary care for patients with depression, due to its focus on patient preferences and its clear-eyed view of possible interventions,” write the authors of an accompanying editorial.

Two of the guideline authors disclosed high-level conflict and were recused from further discussion.

Living Clinical Guideline

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