Screening

Monitoring Outcomes

Treatment Setting

Treatment of Uncomplicated MDD

Treatment of MDD that is Severe or has a Partial or Limited Response to Initial Treatment

Relapse Prevention/Continuation Phase - All Severities and Complexities

Recommendations for Specific Populations

Self-help, Complementary, and Alternative Treatments

Other Treatments with a Recommendation Against Use

Algorithms

Sidebars

Document Overview

Design and created by Guideline Central in participation with the Veterans Health Administration / Department of Defense.

Management of Major Depressive Disorder (MDD)

Veterans Health Administration / Department of Defense

Publication Date: Apr 26, 2022

Page Last Updated: May 5, 2026

Strength of Recommendations in GRADE

Strength	Interpretation	Implications for clinicians	Implications for policymakers
Strong for	Almost all informed patients would choose to receive the intervention	Should be accepted by most patients to whom it is offered	Should be adopted as policy
Weak for	Most informed patients would choose the intervention, but a sizable minority would not	Large role for education and shared decision-making	Requires stakeholder engagement and discussion
Weak against	Most informed patients would not choose the intervention, but a small minority would	Large role for education and shared decision-making	Requires stakeholder engagement and discussion
Strong against	Most patients should not receive the intervention	Should not be offered to patients	Should be adopted as policy

Document Overview

Document Title: Management of Major Depressive Disorder (MDD)

Authoring Society: Veterans Health Administration / Department of Defense

Document Publication Date: Apr 26, 2022

Page Last Reviewed/Updated: May 5, 2026

Document Type: Guideline

Country of Publication: United States

Full Text Freely Available: Yes

Full Text Guideline: www.healthquality.va.gov/guidelines/MH/mdd/VADoDMDDCPGFinal508.pdf

Source Citation: McQuaid JR, Buelt A, Capaldi V, Fuller M, Issa F, Lang AE, Hoge C, Oslin DW, Sall J, Wiechers IR, Williams S. The Management of Major Depressive Disorder: Synopsis of the 2022 U.S. Department of Veterans Affairs and U.S. Department of Defense Clinical Practice Guideline. Ann Intern Med. 2022 Oct;175(10):1440-1451. doi: 10.7326/M22-1603. Epub 2022 Sep 20. PMID: 36122380.

Supplemental Implementation Resources

Document Scope, Criteria, and Use Cases

Scope: Assessment and Screening, Counseling, Diagnosis, Management, Treatment

Diseases/Conditions (MeSH)

D003865 - Depressive Disorder, Major

Keywords: depression, major depressive disorder

Inclusion Criteria: Male, Female, Adult, Older Adult

Health Care Settings: Ambulatory

Intended Users: Addiction Treatment Specialist, Nurse, Nurse Practitioner, Physician, Physician Assistant, Psychologist, Social Worker

Recommendation Development Processes & Methodology

Number of Source Documents: 229

Includes peer/external review process?: Yes

Includes public comment process?: No

Methodologist involvement?: Yes

Patient involvement?: Yes

Includes multi-disciplinary group?: Yes

Includes systematic review?: Yes

Grades quality of strength of evidence?: Yes

Grades quality of strength of recommendation?: Yes

Discloses funding source?: Yes

Discloses conflicts of interest?: Yes

Includes benefits/harms analysis with recommendations?: No

Management of Major Depressive Disorder (MDD)

Screening

Monitoring Outcomes

Treatment Setting

Treatment of Uncomplicated MDD

Treatment of MDD that is Severe or has a Partial or Limited Response to Initial Treatment

Relapse Prevention/Continuation Phase - All Severities and Complexities

Recommendations for Specific Populations

Self-help, Complementary, and Alternative Treatments

Other Treatments with a Recommendation Against Use

Algorithms

Module A: Initial Assessment and Treatment

Module B: Advanced Care Management

Sidebars

Sidebar 1: Risk Assessment and Work-up

Sidebar 2: DSM-5 Criteria

Sidebar 3: Factors to be Considered in Treatment Choice

Sidebar 4: Considerations in Treatment of Uncomplicated MDD

Sidebar 5: Treatment Options for Patients Who Have Not Responded to Adequate Treatment Trials^a

Sidebar 6: Treatment Options for Switching or Augmenting

Sidebar 7: Treatment Options During Remission

Strength of Recommendations in GRADE

Document Overview

Supplemental Implementation Resources

Document Scope, Criteria, and Use Cases

Recommendation Development Processes & Methodology

Management of Major Depressive Disorder (MDD)

Screening

Monitoring Outcomes

Treatment Setting

Treatment of Uncomplicated MDD

Treatment of MDD that is Severe or has a Partial or Limited Response to Initial Treatment

Relapse Prevention/Continuation Phase - All Severities and Complexities

Recommendations for Specific Populations

Self-help, Complementary, and Alternative Treatments

Other Treatments with a Recommendation Against Use

Algorithms

Module A: Initial Assessment and Treatment

Module B: Advanced Care Management

Sidebars

Sidebar 1: Risk Assessment and Work-up

Sidebar 2: DSM-5 Criteria

Sidebar 3: Factors to be Considered in Treatment Choice

Sidebar 4: Considerations in Treatment of Uncomplicated MDD

Sidebar 5: Treatment Options for Patients Who Have Not Responded to Adequate Treatment Trialsa

Sidebar 6: Treatment Options for Switching or Augmenting

Sidebar 7: Treatment Options During Remission

Strength of Recommendations in GRADE

Document Overview

Supplemental Implementation Resources

Document Scope, Criteria, and Use Cases

Recommendation Development Processes & Methodology

Sidebar 5: Treatment Options for Patients Who Have Not Responded to Adequate Treatment Trials^a