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

Abstract

Objectives: To provide advice and guidance regarding the management of mood disorders, derived from scientific evidence and supplemented by expert clinical consensus to formulate s that maximise clinical utility. Methods: Articles and information sourced from search engines including PubMed, EMBASE, MEDLINE, PsycINFO and Google Scholar were supplemented by literature known to the mood disorders committee (e.g. books, book chapters and government reports) and from published depression and bipolar disorder guidelines. Relevant information was appraised and discussed in detail by members of the mood disorders committee, with a view to formulating and developing consensus-based recommendations and clinical guidance. The guidelines were subjected to rigorous consultation and external review involving: expert and clinical advisors, key stakeholders, professional bodies and specialist groups with interest in mood disorders. Results: The Royal Australian and New Zealand College of Psychiatrists mood disorders clinical practice guidelines 2020 (MDcpg2020) provide up-to-date guidance regarding the management of mood disorders that is informed by evidence and clinical experience. The guideline is intended for clinical use by psychiatrists, psychologists, primary care physicians and others with an interest in mental health care. Conclusion: The MDcpg2020 builds on the previous 2015 guidelines and maintains its joint focus on both depressive and bipolar disorders. It provides up-to-date recommendations and guidance within an evidence-based framework, supplemented by expert clinical consensus. Mood disorders committee: Gin S Malhi (Chair), Erica Bell, Darryl Bassett, Philip Boyce, Richard Bryant, Philip Hazell, Malcolm Hopwood, Bill Lyndon, Roger Mulder, Richard Porter, Ajeet B Singh and Greg Murray.

Lifestyle-based mental health care in psychiatry: Translating evidence into practice

“…The recent 2020 RANZCP clinical practice guidelines for mood disorders contain recommendations, resources and advice for psychiatrists, psychologists and General Practitioners providing mental health care for mood disorders (unipolar and bipolar depression) (Malhi et al, 2021). Based on evidence grading, the authors recommend lifestyle targets form part of the ‘Action’ phase of the treatment of mood disorders (Malhi et al, 2021). This includes instituting a healthy diet, sleep hygiene and regular exercise, and addressing smoking and substance use.…”

“…This is framed against a backdrop of implementing education, psychological and social supports as well as addressing barriers and monitoring outcomes. Care within this phase ‘needs to be undertaken to facilitate functional recovery ’; therefore addressing lifestyle behaviours is now positioned as a foundational feature of management (Malhi et al, 2021). This recommended approach to treatment also recognises the need to implement long-term sustainable and preventive lifestyle strategies for mood disorders rather than primarily focusing on management of acute episodes.…”

“…Given the burden of mental disorders and limitations of existing approaches to prevention and treatment in mental health care, we urgently need to bridge the evidence–practice gap to bring lifestyle-based mental health care to people living with mental illness. The recent 2020 Royal Australian and New Zealand College of Psychiatrists (RANZCP) clinical practice guidelines for mood disorders represents a significant milestone in this process (Malhi et al, 2021). These guidelines recommend that dietary, exercise and sleep improvement, alongside smoking, alcohol and other substance use cessation, should form the foundation of mood disorder management, describing it as ‘essentially non-negotiable’ (Malhi et al, 2021).…”

“…The recent 2020 Royal Australian and New Zealand College of Psychiatrists (RANZCP) clinical practice guidelines for mood disorders represents a significant milestone in this process (Malhi et al, 2021). These guidelines recommend that dietary, exercise and sleep improvement, alongside smoking, alcohol and other substance use cessation, should form the foundation of mood disorder management, describing it as ‘essentially non-negotiable’ (Malhi et al, 2021). Here, we discuss the future directions needed to translate and firmly embed lifestyle-based mental health care into practice.…”

Letter to the Editor: Antidepressants and sexual adverse effects

“…Agitated depression can indicate a ‘mixed state’, 1a , 2a and the possibility of bipolarity (a history of a manic episode) should be examined in any patient presenting with an agitated depression. However, our article was referring to the more common situation in which an agitated depression is not part of a bipolar illness.…”