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

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.

Major depressive disorders and bipolar disorders in older adults: Commentary on the RANCZP mood disorders guideline summaries

“…The clinical practice guideline summaries by Malhi et al 1,2 provide accessible reference information on the treatment of major depressive disorder and bipolar disorder for clinicians. Guideline summaries judiciously distil key points and to do this some important information must be excluded.…”

The 2020 mood disorders clinical practice guidelines: Translating evidence into practice with both style and substance

“…The editorial by Marx et al (2021) echoes the recommendations by the mood disorders clinical practice guidelines (CPGs) concerning lifestyle interventions (Malhi et al, 2021). The CPGs place lifestyle changes firmly as the cornerstone of management and as the foundation of the Actions that must be considered at the outset of treatment (Malhi et al, 2020a, 2020b). These, along with psychological interventions, provide the base upon which a framework for pharmacotherapy and Alternatives can be constructed.…”

Channelling a response to difficult-to-treat depression: A need for ratiocination, not rash assassination!

“…We read with great interest the comments by the posse of professors from around the world led by McAllister-Williams and were suitably gratified by the positive endorsement of our recently published mood disorders guidelines (MDcpg 2020 ; Malhi et al, 2021), which incidentally are also available as summaries (Malhi et al, 2020a, 2020b). We were heartened for example by their pleasing comment regarding the content of the MDcpg 2020 that ‘ there is much of value, certainly regarding medications ’ (McAllister-Williams et al, 2021), but were somewhat at a loss as to why they had stopped short of descriptions used by others such as ‘intellectually dazzling’ (Rosenman, 2021).…”