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Research Summary

ACP Updates MDD Treatment Guidelines

Leigh Precopio
02/15/2023

The American College of Physicians (ACP) has updated its guidelines on nonpharmacologic and pharmacologic options as both initial and second-line treatments for adults in the acute phase of major depressive disorder (MDD).

These guidelines are an update to the group’s 2016 recommendation statement on treatment for MDD. The recommendations now focus on the acute phase of treatment for MDD, in which symptoms are treated to resolution. The update also includes new evidence on second-line treatments, as well as consideration of patient values and preferences and cost of interventions.

Among the new recommendations included in this update:

  • Monotherapy with either cognitive behavior therapy (CBT) or a second-generation antidepressant is recommended as initial treatment for patients in the acute phase of moderate to severe MDD (strong recommendation, moderate-certainty evidence).
  • Combination therapy with CBT and a second-generation antidepressant may be used as initial treatment for patients in the acute phase of moderate to severe MDD, depending on patient-specific factors (conditional recommendation, low-certainty evidence).
  • Depending on patient-specific factors, patients in the acute phase of moderate to severe MDD who did not respond to initial treatment may:
    • Switch or augment treatment with CBT (conditional recommendation, low-certainty evidence)
    • Switch to a different second-generation antidepressant or augment with a second pharmacologic treatment (conditional recommendation, low-certainty evidence)
  • Monotherapy with CBT is recommended as initial treatment for patients in the acute phase of mild MDD (conditional recommendation, low-certainty evidence).

Although comparative effectiveness was examined between treatment options, the authors did not compare the effectiveness of these treatment options to those without treatment, which is a limitation. Additional research is needed on other outcomes important to patients such as quality of life and new nonpharmacologic treatments.

 

Reference:

Qaseem A, Owens DK, Etxeandia-Ikobaltzeta I, Tufte J, Cross JT, Wilt TJ; Clinical Guidelines Committee of the American College of Physicians. Nonpharmacologic and pharmacologic treatments of adults in the acute phase of major depressive disorder: a living clinical guideline from the American College of Physicians. Ann Inter Med. Published online January 24, 2023. https://www.acpjournals.org/doi/10.7326/M22-2056