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American College of Physicians (ACP) updates on first-line and second-line therapies during the acute phase of major depressive disorder episodes.
The recently updated clinical guidelines by the ACP put forward the clinical recommendations on pharmacologic and non-pharmacologic interventions as first- and second-line therapies during the acute phase of an episode of major depressive disorder (MDD, also called 'clinical depression') in adults. These guidelines are based on an up-to-date systematic review of the finest available evidence on the relative benefits and harms, keeping in view the patient values and preferences, and prices.
The guideline audience comprised healthcare professionals who treat MDD-affected people in their acute stage of ambulatory care. The recommendations are as under:
Recommendation 1a: The use of cognitive behavioral therapy (CBT) as monotherapy or a second-generation antidepressant as first therapy for the acute stage of moderate to severe MDD (strong recommendation; moderate-certainty evidence as assessed by GRADE).
Recommendation 1b: Combined use of CBT and a second-generation antidepressant drug as first therapy for MDD (conditional recommendation; low-certainty evidence as assessed by GRADE).
Recommendation 2: The use of monotherapy with CBT as initial treatment for acute stage of MDD (conditional recommendation; low-certainty evidence as assessed by GRADE).
Recommendation 3: For the people in the acute stage of moderate to severe MDD who did not respond to first treatment with a suitable dosage of a second-generation antidepressant drug (such as selective serotonin reuptake inhibitors [SSRIs], serotonin and norepinephrine reuptake inhibitors [SNRIs], etc.), ACP suggests one of the following points:
The use of recommendations should be tailored (on an individual basis) and based on the discussion of possible treatment benefits, harms, adverse effects, prices, feasibility, and specific symptoms of the patient [for example, insomnia (lack of sleep), hypersomnia (excessive sleepiness), or change in appetite], comorbidities, medicine use, and choices of the patient.
Annals of Internal Medicine
Nonpharmacologic and Pharmacologic Treatments of Adults in the Acute Phase of Major Depressive Disorder: A Living Clinical Guideline From the American College of Physicians
Amir Qaseem et al.
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