Major Depressive Disorder Guidelines Issued By American Psychiatric Association

The new guidelines for major depressive disorder by the American Psychiatric Association (APA) are an update on the last ones issued in 2000, they include recommendations on electro-convulsive therapy and other somatic treatments, antidepressant drugs, psychotherapies and new evidence based therapies. The APA says its new guidelines also addresses alterative and complementary therapies, treatment approaches for depression in pregnant mothers, and recommendations for depression cases that do not respond to treatment.


Alan J. Gelenberg, M.D., chair of the work group that prepared the guidelines, said:


The five-year process of intense review, discussion and thoughtful revision-making has led us to
today's release of new guidelines that we believe will improve patient care. We are hopeful these
guidelines will lead to improved lives for many patients.


The APA informs that the 100-member group which drafted the guidelines consisted of clinical experts in the treatment and assessment of major depressive disorder, patient advocacy groups and APA members. They examined more than 13,000 peer-reviewed articles that had been published since 1999, the cut-off point for the previous guidelines, to 2006.


The new guidelines include the following key changes:

Rating scales - a doctor- and/or patient-administered rating scale should be used to assess the type, frequency, and severity of psychiatric symptoms so that treatment can be tailored to match patient needs.
Treatment-resistant depression - electroconvulsive therapy has compelling evidence in its favor as treatment for individuals who have not responded to several medication trials. Additional potential treatments include vagus nerve stimulation and transcranial magnetic stimulation. Another option may also be the administration of MAOIs (monoamine oxidase inhibitors).
Physical activity - aerobic exercise and/or resistance training have, according to randomized and controlled trials provided modest improvement in mood symptoms. Depressive symptoms rates in the general population may also be brought down through regular exercise; especially among elderly individuals and patients who also have other medical problems.
Stronger maintenance treatment - patients who have risk factors for recurrence should receive stronger maintenance treatment (after continuation phase). Patients with chronic illness, as well as those who have had at least three previous depressive episodes should receive maintenance treatment.

Major Depressive Disorder
The symptoms of Major Depression or Major Depressive Disorder can seriously affect the patient's family and personal relationships, as well as work and/or school life. The impact can eventually affect the individual's physical health. The effect on functioning and well-being can be as debilitating as diabetes or other serious chronic conditions, say experts.
An individual who has a major depressive episode may:

Have a very low mood which spreads through all aspects of their life
Find it extremely difficult to enjoy activities which used to be pleasurable
Have continuous feelings and thoughts of worthlessness, exaggerated or inappropriate guilt, helplessness and self-hatred.
There may be symptoms of psychosis in very severe cases
Find it hard to concentrate and focus on things
Those with melancholic or psychotic features may have memory problems
Have a reduced libido (sex drive)
Withdraw from social situations and activities
Have thoughts of suicide and/or death
Fatigue, headaches and digestive problems may also be exhibited

A significant number of individuals with major depressive disorder suffer from insomnia - according to the NIH (National Institutes of Health), 4 in every 5 people with depression have insomnia. In some cases the problem may be oversleeping - hypersomnia.