Getting depression clinical practice guidelines right: time for change?
Version of Record online: 2 AUG 2013
© 2013 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd
Acta Psychiatrica Scandinavica
Special Issue: Chronobiology of Mood Disorders and Manipulating Melatonin in Managing Mood
Volume 128, Issue Supplement s444, pages 24–30, September 2013
How to Cite
Getting depression clinical practice guidelines right: are we running out of time?, , , , .
- Issue online: 2 AUG 2013
- Version of Record online: 2 AUG 2013
- major depressive disorder;
- clinical practice guidelines
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.
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.
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.
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.