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New Guidelines for Treatment of Depression

American Psychiatric Association Issues Suggestions on Medication and Talk Therapy
By
WebMD Health News
Reviewed by Laura J. Martin, MD

Oct. 1, 2010 -- Updated guidelines for the treatment of clinical depression include suggestions on the use of medication, talk therapy, exercise, and alternative treatments, while urging doctors to more closely assess symptoms and tailor treatments to the patient.

The American Psychiatric Association released the guidelines on major depressive disorder Friday, the first update in 10 years.

Before the release of the new guidelines, an independent panel of depression treatment experts with no ties to industry reviewed the guidelines for any bias, says Joel Yager, MD, a professor of psychiatry at the University of Colorado School of Medicine, Denver, and chair of the American Psychiatric Association’s steering committee on practice guidelines.

The final document, Yager tells WebMD, is a ''verification and validation of the best way to treat depression." The group took five years to research and create the guidelines, Yager says.

Nearly one in 10 U.S. adults has depression, the CDC reported this week. About 3.4% of those meet the criteria for major depression, the type addressed in the guidelines.

Guidelines at a Glance

Yager recapped some of the highlights of the guidelines for WebMD.

''For mild to moderate depression, talking therapy -- in particular cognitive behavior therapy and interpersonal therapy -- can help reduce the symptoms of depression and prepare people not to be so vulnerable for future depression," Yager says. "There's also good evidence that modern antidepressants are effective as well."

"For more serious cases of depression, there is evidence that the medications really matter," he says. ''Talking therapy can be additionally helpful, but if you have a serious depression the odds are you are going to require these medications."

Specifics of Depression Treatment Guidelines

The new guidelines address depression that resists traditional treatment, suggesting that electroconvulsive therapy (ECT) has the best supporting data. In ECT, electric currents are passed through the brain to change brain chemistry and help ease symptoms.

"Electroconvulsive therapy has been around a long time," Yager says. "The evidence [for its effectiveness] remains strong for very serious depression that doesn't respond."

He likens ECT to putting paddles on the chest for heart emergencies. "Paddles on the brain will bring you back," he says.

For resistant depression, the guidelines also address other potential treatments, including older medications known as monoamine oxidase inhibitor (MAOIs) as well as two newer options: transcranial magnetic stimulation (the use of magnetic fields to stimulate nerve cells in the brain and relieve symptoms) and vagus nerve stimulation (the use of electrical impulses in the brain).

Exercise is addressed as a way to see a modest improvement in mood symptoms, with either aerobic exercise or resistance training a help. "It pumps you up a little bit, makes you feel not as ineffective," Yager says.

Under the guidelines, doctors are also urged to rate their patients' symptoms more specifically than they may do now.

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