The American Psychiatric Association (APA) has released a new clinical practice guideline that summarizes specific approaches to treatment for people with major depressive disorder. The updated guideline includes new evidence-based recommendations on treatment decisions and addresses other topics, such as alternative and complementary therapies, treating depression during pregnancy and approaches to treating treatment-resistant depression.
The guideline includes a few key changes from the previous version, last updated 10 years ago. A clinician and/or patient administered rating scale is now recommended to assess the type, frequency, and strength of psychiatric symptoms in order to tailor the treatment plan to match the needs of the person. The guidelines also include the use of transcranial magnetic stimulation and vagus nerve stimulation as potential treatments for people experiencing treatment-resistant depression. As well, beyond the initial and continuation treatment phases, the authors have strengthened the recommendation for maintenance treatment, especially for people at risk of recurrence and those with chronic illness.
The guideline has also been updated to include information on randomized, controlled trials that found at least a modest improvement in mood for people who include aerobic exercise or resistance training as part of their therapy. The authors additionally highlight the anti-depressive effects of regular exercise among the general population, especially older adults and those with co-occurring medical issues.
See “Practice Guideline for the Treatment of Patients with Major Depressive Disorder, Third Edition,” American Psychiatric Association, October 2010, available at www.psych.org.