Depression treatment guidelines updated

By Dr. Ananya Mandal, MDOct 4 2010

There has been an update in the treatment of clinical depression. This includes suggestions on the use of medication, talk therapy, exercise, and alternative treatments and puts more emphasis on tailor made treatments for patients.

The guidelines were released by the American Psychiatric Association last Friday entitled “Practice Guideline for Treatment of Patients with Major Depressive Disorder,” and this is their first update since 10 years. Joel Yager a professor of psychiatry at the University of Colorado School of Medicine, Denver, and chair of the American Psychiatric Association’s steering committee on practice guidelines said that this release was preceded by discussion an independent panel of depression treatment experts with no ties to industry. He said that the final guideline is a “verification and validation of the best way to treat depression.” The group took five years to come up with the guidelines.

Some of the main highlights of the guidelines were outlined by Yager.

• “For mild to moderate depression, talking therapy - in particular cognitive behavior therapy and interpersonal therapy - can help reduce the symptoms of depression and prepare people not to be so vulnerable for future depression…There's also good evidence that modern antidepressants are effective as well.”
• “For more serious cases of depression, there is evidence that the medications really matter…Talk therapy can be additionally helpful, but if you have a serious depression the odds are you are going to require these medications.”
• For depression that resists traditional treatment, suggesting that electroconvulsive therapy (ECT). In ECT, electric currents are passed through the brain to change brain chemistry and help ease symptoms. “Electroconvulsive therapy has been around a long time…The evidence [for its effectiveness] remains strong for very serious depression that doesn't respond,” he said. For this type of depression the guidelines suggest other potential treatments, including older medications known as monoamine oxidase inhibitor (MAOIs) as well as two newer options: transcranial magnetic stimulation (the use of magnetic fields to stimulate nerve cells in the brain and relieve symptoms) and vagus nerve stimulation (the use of electrical impulses in the brain).
• On exercise Yager said the guidelines suggest that there is a modest improvement of mood.
• For clinical evaluation of efficacy instead of simply asking “How are you today?" doctors are urged to ask, “On a scale of one to 10, how are you feeling today?” Yager says. He explained that more specific questioning may help doctors gauge treatment effects better and help patients see a pattern in their moods and symptoms.
• The guidelines also emphasize on the value of maintenance treatment. “If someone has had three or more episodes of depression, they really should probably stay on their medication continuously the way you would stay on insulin if you are diabetic,” Yager said.
• The guidelines also discuss depression management in pregnancy. The choice of continuation of anti depressants and risks associated with continuation or discontinuation should be discussed with the doctor.
• The guidelines go for tailor made therapy. This means one size does not fit all and individual patient should be treated as bests suited for him or her.