Peter Ellis, Chair (Correspondence) CPG Team for Treatment of Depression, Wellington School of Medicine and Health Sciences, University of Otago, Wellington, New Zealand. Email: firstname.lastname@example.org
Australian and New Zealand clinical practice guidelines for the treatment of depression
Article first published online: 11 JUN 2004
Australian and New Zealand Journal of Psychiatry
Volume 38, Issue 6, pages 389–407, June 2004
How to Cite
Royal Australian and New Zealand College of Psychiatrists Clinical Practice Guidelines Team for Depression (2004), Australian and New Zealand clinical practice guidelines for the treatment of depression. Australian and New Zealand Journal of Psychiatry, 38: 389–407. doi: 10.1111/j.1440-1614.2004.01377.x
- Issue published online: 11 JUN 2004
- Article first published online: 11 JUN 2004
- Received 13 February 2004; accepted 30 March 2004.
- evidence-based review;
- treatment guideline.
Background: The Royal Australian and New Zealand College of Psychiatrists (RANZCP) is co-ordinating the development of clinical practice guidelines (CPGs) in psychiatry, funded under the National Mental Health Strategy (Australia) and the New Zealand Ministry of Health.
Method: The CPG team reviewed the treatment outcome literature, consulted with practitioners and patients and conducted meta-analyses of outcome research.
Treatment recommendations: Establish an effective therapeutic relationship; provide the patient with information about the condition, the rationale for treatment, the likelihood of a positive response and the expected timeframe; consider the patient's strengths, life stresses and supports. Treatment choice depends on the clinician's skills and the patient's circumstances and preferences, and should be guided but not determined by these guidelines. In moderately severe depression, all recognized antidepressants, cognitive behavioural therapy (CBT) and interpersonal psychotherapy (IPT) are equally effective; clinicians should consider treatment burdens as well as benefits, including side-effects and toxicity. In severe depression, antidepressant treatment should precede psychological therapy. For depression with psychosis, electroconvulsive therapy (ECT) or a tricyclic combined with an antipsychotic are equally helpful. Treatments for other subtypes are discussed. Caution is necessary in people on other medication or with medical conditions. If response to an adequate trial of a first-line treatment is poor, another evidence-based treatment should be used. Second opinions are useful. Depression has a high rate of recurrence and efforts to reduce this are crucial.