Synopsis of the Clinical Practice Guidelines for Diagnosis and Treatment of Depression in Primary Care
The Depression Guideline Panel of the Agency for Health Care Policy and Research
Arch Fam Med. 1994;3(1):85-92.
The cost—pain, suffering, disability, death, and dollar costs—of major depressive disorder is very high. The social stigma surrounding depression adds to these costs, as it interferes with the optimal use of current knowledge and treatments, contributes to underrecognition and underdiagnosis, and delays or prevents early treatment. The efficacy of medication is very clear, based on over 250 randomized, double-blind, controlled, acute-phase trials, although only 50% to 60% of patients will respond to any single medication trial. Time-limited psychotherapy alone as a treatment for less severe, nonpsychotic forms of major depressive disorder is clearly more effective than a wait-listed control comparison group based on randomized trials, and in the eight studies that have compared time-limited therapy with a combination medication treatment and clinical management, equal efficacy has been found. In the few studies available, the combination of medication treatment and time-limited psychotherapy has offered no advantage over medication treatment or psychotherapy alone in terms of symptom relief, although the psychosocial complications of depression may be better remediated if psychotherapy is a part of the treatment package. However, combination treatment may provide an advantage for more chronic or complicated forms of major depressive disorder. Electroconvulsive therapy is clearly effective in many with severe or psychotic depression who have failed to respond to medication treatment. Light therapy appears effective for some patients with seasonal depression. Guidelines for selecting initial treatment and switching or augmenting treatments are discussed.
Members of the Depression Guideline Panel of the Agency for Health Care Policy and Research are listed at the end of the article.
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