Getting depression clinical practice guidelines right: time for change?

Abstract

OBJECTIVE:

As part of a series of papers ['Chronobiology of mood disorders' Malhi & Kuiper. Acta Psychiatr Scand 2013;128(Suppl. 444):2-15; and 'It's time we managed depression: The emerging role of chronobiology' Malhi et al. Acta Psychiatr Scand 2013;128(Suppl. 444):1] examining chronobiology in the context of depression, this article examines recent western clinical practice guidelines (CPGs) for the treatment of depression with respect to the recommendations they make, in particular as regards chronobiological treatments, and briefly considers the implications of their methodology and approach.

METHOD:

Five international treatment guidelines, which had been published in the past 5 years, were identified, representing North American and European views. Chosen guidelines were reviewed by the authors, and the relevant recommendations were distributed for discussion and subsequent synthesis.

RESULTS:

Most current guidelines do not address chronobiology in detail. Chronotherapeutic recommendations are tentative, although agomelatine is considered as an option for major depression and bright light therapy for seasonal affective disorder. Sleep deprivation is not routinely recommended.

CONCLUSION:

Recommendations are limited by the lack of reliable therapeutic markers for chronotherapeutics. Current evidence supports use of light therapy in seasonal depression, but in non-seasonal depression there is insufficient evidence to support reliance on chronotherapeutics over existing treatment modalities.

• Authors: S Kuiper, L McLean, K Fritz, L Lampe, G S Malhi
• Journal: Acta psychiatrica Scandinavica. Supplementum (Acta Psychiatr Scand Suppl) Issue 444 Pg. 24-30 ( 2013) ISSN: 1600-5473 [Electronic] Denmark
• PMID: 23909694 (Publication Type: Journal Article, Review)
• Copyright: © 2013 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Topics

• Depressive Disorder (therapy)
• Humans
• Periodicity
• Practice Guidelines as Topic