The 2020 Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for mood disorders: Major depression summary

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  • Gin S. Malhi
    Department of Psychiatry Northern Clinical School Faculty of Medicine and Health The University of Sydney Sydney NSW Australia
  • Erica Bell
    Department of Psychiatry Northern Clinical School Faculty of Medicine and Health The University of Sydney Sydney NSW Australia
  • Ajeet B. Singh
    The Geelong Clinic Healthscope IMPACT – Institute for Mental and Physical Health and Clinical Translation School of Medicine Deakin University Geelong VIC Australia
  • Darryl Bassett
    Consultant Psychiatrist Perth WA Australia
  • Michael Berk
    IMPACT – the Institute for Mental and Physical Health and Clinical Translation School of Medicine Barwon Health Deakin University Geelong Australia
  • Philip Boyce
    Department of Psychiatry Westmead Hospital and the Westmead Clinical School Wentworthville NSW Australia
  • Richard Bryant
    School of Psychology University of New South Wales Sydney NSW Australia
  • Michael Gitlin
    Department of Psychiatry Geffen School of Medicine at UCLA Los Angeles CA USA
  • Amber Hamilton
    Department of Psychiatry Northern Clinical School Faculty of Medicine and Health The University of Sydney Sydney NSW Australia
  • Philip Hazell
    Discipline of Psychiatry Sydney Medical School Faculty of Medicine and Health University of Sydney Sydney NSW Australia
  • Malcolm Hopwood
    Department of Psychiatry University of Melbourne and Professorial Psychiatry Unit Albert Road Clinic Melbourne Vic. Australia
  • Bill Lyndon
    Department of Psychiatry Northern Clinical School Faculty of Medicine and Health The University of Sydney Sydney NSW Australia
  • Roger S. McIntyre
    Mood Disorders Psychopharmacology Unit University Health Network Toronto ON Canada
  • Grace Morris
    Department of Psychiatry Northern Clinical School Faculty of Medicine and Health The University of Sydney Sydney NSW Australia
  • Roger Mulder
    Department of Psychological Medicine University of Otago Christchurch New Zealand
  • Richard Porter
    Department of Psychological Medicine University of Otago Christchurch New Zealand
  • Lakshmi N. Yatham
    Department of Psychiatry University of British Columbia Vancouver British Columbia Canada
  • Allan Young
    Department of Psychological Medicine Institute of Psychiatry, Psychology, and Neuroscience King's College London London UK
  • Greg Murray
    Centre for Mental Health Swinburne University of Technology Hawthorn VIC Australia

Abstract

<jats:title>Abstract</jats:title><jats:sec><jats:title>Objectives</jats:title><jats:p>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 (MDcpg<jats:sup>2020</jats:sup>).</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>To develop the MDcpg<jats:sup>2020</jats:sup>, 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 MDcpg<jats:sup>2020</jats:sup>, 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.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>The depression summary provides a systematic approach to diagnosis, and a logical clinical framework for management. The latter begins with <jats:italic>Actions</jats:italic>, 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 <jats:italic>Choices</jats:italic> and nominates seven medications that can be trialled as clinically indicated before moving to <jats:italic>Alternatives</jats:italic> 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.</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>The major depression summary provides up to date guidance regarding the management of major depressive disorder, as set out in the MDcpg<jats:sup>2020</jats:sup>. 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.</jats:p></jats:sec>

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