Nonpharmacologic and Pharmacologic Treatments of Adults in the Acute Phase of Major Depressive Disorder

Publication Date: January 24, 2023
Last Updated: January 31, 2023

Summary of Recommendations

Recommendation 1a

ACP recommends monotherapy with either cognitive behavioral therapy or a second-generation antidepressant as initial treatment in patients in the acute phase of moderate to severe major depressive disorder. (S, M)
620

Recommendation 1b

ACP suggests combination therapy with cognitive behavioral therapy and a second-generation antidepressant as initial treatment in patients in the acute phase of moderate to severe major depressive disorder. (C, L)
The informed decision on the options of monotherapy with cognitive behavioral therapy versus second-generation antidepressants or combination therapy should be personalized and based on discussion of potential treatment benefits, harms, adverse effect profiles, cost, feasibility, patients' specific symptoms (such as insomnia, hypersomnia, or fluctuation in appetite), comorbidities, concomitant medication use, and patient preferences.
620

Recommendation 2

ACP suggests monotherapy with cognitive behavioral therapy as initial treatment in patients in the acute phase of mild major depressive disorder. (C, L)
620

Recommendation 3

ACP suggests one of the following options for patients in the acute phase of moderate to severe major depressive disorder who did not respond to initial treatment with an adequate dose of a second-generation antidepressant:
Switching to or augmenting with cognitive behavioral therapy (C, L)
620
Switching to a different second-generation antidepressant or augmenting with a second pharmacologic treatment (C, L)
620
The informed decision on the options should be personalized and based on discussion of potential treatment benefits, harms, adverse effect profiles, cost, feasibility, patients' specific symptoms (such as insomnia, hypersomnia, or fluctuation in appetite), comorbidities, concomitant medication use, and patient preferences.

Recommendation Grading

Overview

Title

Nonpharmacologic and Pharmacologic Treatments of Adults in the Acute Phase of Major Depressive Disorder

Authoring Organization

Publication Month/Year

January 24, 2023

Last Updated Month/Year

June 14, 2023

Supplemental Implementation Tools

Document Type

Guideline

Country of Publication

US

Document Objectives

The purpose of this guideline from the American College of Physicians (ACP) is to present updated clinical recommendations on nonpharmacologic and pharmacologic interventions as initial and second-line treatments during the acute phase of a major depressive disorder (MDD) episode, based on the best available evidence on the comparative benefits and harms, consideration of patient values and preferences, and cost.

Target Patient Population

Adults in the acute phase of MDD.

Target Provider Population

Clinicians caring for adult patients in the acute phase of MDD in ambulatory care

Inclusion Criteria

Male, Female, Adult, Older adult

Health Care Settings

Ambulatory

Intended Users

Nurse, nurse practitioner, physician, physician assistant

Scope

Treatment

Diseases/Conditions (MeSH)

D003863 - Depression, D003865 - Depressive Disorder, Major, D003866 - Depressive Disorder

Keywords

depression, major depressive disorders, major depressive disorder, MDD

Source Citation

Qaseem A, Owens DK, Etxeandia-Ikobaltzeta I, Tufte J, Cross JT Jr, Wilt TJ; Clinical Guidelines Committee of the American College of Physicians†. Nonpharmacologic and Pharmacologic Treatments of Adults in the Acute Phase of Major Depressive Disorder: A Living Clinical Guideline From the American College of Physicians. Ann Intern Med. 2023 Jan 24. doi: 10.7326/M22-2056. Epub ahead of print. PMID: 36689752.

Supplemental Methodology Resources

Methodology Supplement, Data Supplement

Methodology

Number of Source Documents
129
Literature Search Start Date
January 1, 1990
Literature Search End Date
August 8, 2022