Whew. This wasn’t easy. But it was necessary. And I hope useful for years to come.
A work group of the American Psychiatric Association just finished a 4-year gargantuan effort to revise and update the Major Depressive Disorder Treatment Guideline. And the APA has now formally approved the document.
I chaired the work group, made up of esteemed scholars, scientists and clinicians who gave generously of their time and talents. Together we considered how much had changed since the second version of the guideline came out in 2000.
- New medications have been studied in short- and long-term trials.
- Drugs have been approved as adjuncts.
- New forms of psychotherapy have been created and studied.
- Nutritional supplements and exercise have been proposed and studied.
- New stimulation interventions are available.
The work group looked carefully at each, and debated the pros and cons on their scientific merits. Some of the new treatments met the test for recommendation by this work group, and subsequently by the APA.
While there are many effective treatments, both new and old, as a whole, available options leave much to be desired. Even after repeated treatments with a variety of medications and methodology, as many as one third of patients will remain symptomatic. There remains a tremendous need.
Given our current limitations, however, I am confident the new guidelines will help clinicians choose among a wide variety of approved treatments, from diet and exercise to brain stimulation. And our work must continue.