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

Gin S Malhi, Tim Outhred, Amber Hamilton, Philip M Boyce, Richard Bryant, Paul B Fitzgerald, Bill Lyndon, Roger Mulder, Greg Murray, Richard J Porter, Ajeet B Singh and Kristina Fritz
Med J Aust 2018; 208 (5): 1. || doi: 10.5694/mja17.00659

Abstract

Introduction: In December 2015, the Royal Australian and New Zealand College of Psychiatrists published a comprehensive set of mood disorder clinical practice guidelines for psychiatrists, psychologists and mental health professionals. This guideline summary, directed broadly at primary care physicians, is an abridged version that focuses on major depression. It emphasises the importance of shared decision making, tailoring personalised care to the individual, and delivering care in the context of a therapeutic relationship. In practice, the management of depression is determined by a multitude of factors, including illness severity and putative aetiology, with the principal objectives of regaining premorbid functioning and improving resilience against recurrence of future episodes.

Main recommendations: The guidelines emphasise a biopsychosocial lifestyle approach and provide the following specific clinical recommendations:

  • Alongside or before prescribing any form of treatment, consideration should be given to the implementation of strategies to manage stress, ensure appropriate sleep hygiene and enable uptake of healthy lifestyle changes.
  • For mild to moderate depression, psychological management alone is an appropriate first line treatment, especially early in the course of illness.
  • For moderate to severe depression, pharmacological management is usually necessary and is recommended first line, ideally in conjunction with psychosocial interventions.

 

Changes in management as a result of the guidelines: The management of depression is anchored within a therapeutic relationship that attends to biopsychosocial lifestyle aspects and psychiatric diagnosis. The guidelines promote a broader approach to the formulation and management of depression, with treatments tailored to depressive subtypes and administered with clear steps in mind. Lifestyle and psychological therapies are favoured for less severe presentations, and concurrent antidepressant prescription is reserved for more severe and otherwise treatment-refractory cases.

  • Gin S Malhi1,2
  • Tim Outhred1,2
  • Amber Hamilton1,2
  • Philip M Boyce3
  • Richard Bryant4
  • Paul B Fitzgerald5,6
  • Bill Lyndon2,7
  • Roger Mulder8
  • Greg Murray9
  • Richard J Porter8
  • Ajeet B Singh10
  • Kristina Fritz1,2

  • 1 CADE Clinic, Royal North Shore Hospital, Sydney, NSW
  • 2 Northern Clinical School, University of Sydney, Sydney, NSW
  • 3 Westmead Clinical School, University of Sydney, Sydney, NSW
  • 4 UNSW Sydney, Sydney, NSW
  • 5 Epworth Clinic, Epworth Healthcare, Melbourne, VIC
  • 6 Monash Alfred Psychiatry Research Centre, Central Clinical School, Monash University, Melbourne, VIC
  • 7 Mood Disorders Unit, Northside Clinic, Sydney, NSW
  • 8 University of Otago, Christchurch, NZ
  • 9 Swinburne University of Technology, Melbourne, VIC
  • 10 Deakin University, Geelong, VIC

Correspondence: gin.malhi@sydney.edu.au

Acknowledgements: 

The development of the clinical practice guidelines for mood disorders was supported and funded by the RANZCP.

Competing interests:

Gin Malhi has received grant or research support from Australian Rotary Health, the NHMRC, the American Foundation for Suicide Prevention, NSW Health, Ramsay Health, the University of Sydney, AstraZeneca, Eli Lilly, Organon, Pfizer, Servier and Wyeth; has been a speaker for AstraZeneca, Eli Lilly, Janssen-Cilag, Lundbeck, Pfizer, Ranbaxy, Servier and Wyeth; and has been a consultant for AstraZeneca, Eli Lilly, Janssen-Cilag, Lundbeck and Servier. Phillip Boyce has received consultation fees, sponsorship and speaker fees from Servier; is a member of the advisory board for Lundbeck, Eli Lilly, AstraZeneca and Janssen; has received speaker fees from Lundbeck, AstraZeneca and Janssen; and has received funding for a clinical trial from Brain Resource Company. Richard Bryant has received an NHMRC Program Grant and Project Grant. Paul Fitzgerald is supported by an NHMRC Practitioner Fellowship Grant; and has received equipment for research from MagVenture A/S, Medtronic Ltd, Neuronetics and Brainsway Ltd, and funding for research from Neuronetics. He is on scientific advisory boards for Bionomics Ltd and LivaNova and is a founder of TMS Clinics Australia. Bill Lyndon has received personal fees from Lundbeck Australia, AstraZeneca and Eli Lilly Australia. Greg Murray has received an NHMRC Project Grant and personal fees from Servier and CSL Biotherapies. Ajeet Singh has received personal fees from Servier Australia and Lundbeck Australia; has received a grant from Pfizer Australia; has equity in LifeLetters.com; is the founder and owner of CNSdose.com website; and has a patent on the Antidepressant Pharmacogenetics Report.

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