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

Gin S Malhi^{1

2

3}, Erica Bell^{1

2

3}, Ajeet B Singh⁴, Darryl Bassett⁵, Michael Berk^{6

7}, Philip Boyce^{8

9}, Richard Bryant¹⁰, Michael Gitlin¹¹, Amber Hamilton^{1

2

3}, Philip Hazell⁹, Malcolm Hopwood¹², Bill Lyndon¹, Roger S McIntyre¹³, Grace Morris^{1

2

3}, Roger Mulder¹⁴, Richard Porter¹⁴, Lakshmi N Yatham¹⁵, Allan Young^{16

17}, Greg Murray¹⁸

Affiliations

¹ Department of Psychiatry, Northern Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.
² Academic Department of Psychiatry, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, NSW, Australia.
³ CADE Clinic, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, NSW, Australia.
⁴ The Geelong Clinic Healthscope, IMPACT - Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Deakin University, Geelong, VIC, Australia.
⁵ Consultant Psychiatrist, Perth, WA, Australia.
⁶ IMPACT - the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Deakin University, Geelong, Australia.
⁷ Orygen, The National Centre of Excellence in Youth Mental Health, The Florey Institute and the Department of Psychiatry, The University of Melbourne, Parkville, Vic., Australia.
⁸ Department of Psychiatry, Westmead Hospital and the Westmead Clinical School, Wentworthville, NSW, Australia.
⁹ Discipline of Psychiatry, Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia.
¹⁰ School of Psychology, University of New South Wales, Sydney, NSW, Australia.
¹¹ Department of Psychiatry, Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
¹² Department of Psychiatry, University of Melbourne and Professorial Psychiatry Unit, Albert Road Clinic, Melbourne, Vic., Australia.
¹³ Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada.
¹⁴ Department of Psychological Medicine, University of Otago, Christchurch, New Zealand.
¹⁵ Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada.
¹⁶ Department of Psychological Medicine, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK.
¹⁷ South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Beckenham, UK.
¹⁸ Centre for Mental Health, Swinburne University of Technology, Hawthorn, VIC, Australia.

PMID: 33320412
DOI: 10.1111/bdi.13035

Review

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

Gin S Malhi et al. Bipolar Disord. 2020 Dec.

. 2020 Dec;22(8):788-804.

doi: 10.1111/bdi.13035.

Authors

Affiliations

¹ Department of Psychiatry, Northern Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.
² Academic Department of Psychiatry, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, NSW, Australia.
³ CADE Clinic, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, NSW, Australia.
⁴ The Geelong Clinic Healthscope, IMPACT - Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Deakin University, Geelong, VIC, Australia.
⁵ Consultant Psychiatrist, Perth, WA, Australia.
⁶ IMPACT - the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Deakin University, Geelong, Australia.
⁷ Orygen, The National Centre of Excellence in Youth Mental Health, The Florey Institute and the Department of Psychiatry, The University of Melbourne, Parkville, Vic., Australia.
⁸ Department of Psychiatry, Westmead Hospital and the Westmead Clinical School, Wentworthville, NSW, Australia.
⁹ Discipline of Psychiatry, Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia.
¹⁰ School of Psychology, University of New South Wales, Sydney, NSW, Australia.
¹¹ Department of Psychiatry, Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
¹² Department of Psychiatry, University of Melbourne and Professorial Psychiatry Unit, Albert Road Clinic, Melbourne, Vic., Australia.
¹³ Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada.
¹⁴ Department of Psychological Medicine, University of Otago, Christchurch, New Zealand.
¹⁵ Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada.
¹⁶ Department of Psychological Medicine, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK.
¹⁷ South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Beckenham, UK.
¹⁸ Centre for Mental Health, Swinburne University of Technology, Hawthorn, VIC, Australia.

PMID: 33320412
DOI: 10.1111/bdi.13035

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.

Keywords: depression; guideline; mood disorders; treatment.

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Comment in

Major depressive disorders and bipolar disorders in older adults: Commentary on the RANCZP mood disorders guideline summaries.
Forbes M, Berk M, Reynolds C. Forbes M, et al. Bipolar Disord. 2021 Jun;23(4):416-417. doi: 10.1111/bdi.13068. Epub 2021 Mar 9. Bipolar Disord. 2021. PMID: 33638272 No abstract available.
The IDeAS in MIDAS: 'Keeping it real!'.
Malhi GS, Bell E, Boyce P, Hopwood M, Bassett D, Mulder R, Porter RJ. Malhi GS, et al. Aust N Z J Psychiatry. 2022 May;56(5):569-570. doi: 10.1177/00048674211011257. Epub 2021 May 19. Aust N Z J Psychiatry. 2022. PMID: 34011200 No abstract available.

References

REFERENCES

1. Malhi GS, Bell E, Bassett D, et al. The Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for mood disorders. Aust N Z J Psychiatry. 2021;55(1):7-117.
1. Malhi GS, Bassett D, Boyce P, et al. Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for mood disorders. Aust N Z J Psychiatry. 2015;49(12):1087-1206.
1. National Health and Medical Research Council. NHMRC additional levels of evidence and grades for recommendations for developers of guidelines. NHMRC. 2009.
1. Bromet E, Andrade LH, Hwang I, et al. Cross-national epidemiology of DSM-IV major depressive episode. BMC Med. 2011;9(1):90.
1. Heim C, Binder EB. Current research trends in early life stress and depression: review of human studies on sensitive periods, gene-environment interactions, and epigenetics. Exp Neurol. 2012;233(1):102-111.

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

Affiliations

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

Authors

Affiliations

Abstract

Comment in

References

REFERENCES

Publication types

MeSH terms

Substances

LinkOut - more resources

Full Text Sources

Medical

Miscellaneous