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

Abstract

In December 2015, the Royal Australian and New Zealand College of Psychiatrists published a comprehensive set of mood disorder clinical practice guidelines for psychiatrists, psychologists and mental health professionals. This guideline summary, directed broadly at primary care physicians, is an abridged version that focuses on major depression. It emphasises the importance of shared decision making, tailoring personalised care to the individual, and delivering care in the context of a therapeutic relationship. In practice, the management of depression is determined by a multitude of factors, including illness severity and putative aetiology, with the principal objectives of regaining premorbid functioning and improving resilience against recurrence of future episodes. Main recommendations: The guidelines emphasise a biopsychosocial lifestyle approach and provide the following specific clinical recommendations: Alongside or before prescribing any form of treatment, consideration should be given to the implementation of strategies to manage stress, ensure appropriate sleep hygiene and enable uptake of healthy lifestyle changes. For mild to moderate depression, psychological management alone is an appropriate first line treatment, especially early in the course of illness. For moderate to severe depression, pharmacological management is usually necessary and is recommended first line, ideally in conjunction with psychosocial interventions. Changes in management as a result of the guidelines: The management of depression is anchored within a therapeutic relationship that attends to biopsychosocial lifestyle aspects and psychiatric diagnosis. The guidelines promote a broader approach to the formulation and management of depression, with treatments tailored to depressive subtypes and administered with clear steps in mind. Lifestyle and psychological therapies are favoured for less severe presentations, and concurrent antidepressant prescription is reserved for more severe and otherwise treatment-refractory cases.

Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for mood disorders: bipolar disorder summary

“…This guideline summary is an abstracted version of the more comprehensive guidelines and accompanies our guideline summary for the treatment for major depression 5 . It overviews the long term management of bipolar disorder within the community, where the general practitioner plays a central role as part of a treatment team that usually consists of a psychiatrist, psychologist and other mental health care professionals.…”

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

“…Based on the Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for mood disorders, 1 Malhi and colleagues have produced guideline summaries for major depression 2 and bipolar disorder 3 …”

“…The major depression summary is likely to be used as a stand‐alone guideline by primary care physicians treating depression 2 . Bipolar disorder often presents as recurrent depression 1 , 3 .…”

“…It is therefore worrying that the major depression summary omits discussion of bipolar disorder. Identifying bipolar disorder is important because the treatment is different from that required for other types of depression 2 , 3 …”

“…The major depression summary 2 recommends lithium, atypical antipsychotics and electroconvulsive therapy for treatment‐resistant depression. Some psychiatrists believe that these are only effective in treating melancholic depression.…”