Updated Guidelines Released on Major Depressive Disorder Management

In February 2022, the US Department of Veterans Affairs (VA) and US Department of Defense (DoD) released an update to the 2016 joint clinical practice guideline (CPG) for the management of major depressive disorder (MDD).

The authors of the updated CPG identified vital new evidence and made changes to prior recommendations in the areas of pharmacologic management, pharmacogenomics, psychotherapy, complementary and alternative therapies, and the use of telemedicine.

“The VA/DoD guideline, which as the most recent evidence review, extends beyond other guidelines, with the update on initial treatment options; the examination of modalities of care, such as telehealth; and the focus on the interventional treatments and use of psychedelic interventions,” the authors wrote.

The management section was significantly changed in the updated 2022 guideline. The 2016 guideline previously divided this section into “treatment of uncomplicated mild to moderate MDD” and “treatment of severe, chronic, or recurrent MDD (complex).” The 2022 guideline divides this section into “treatment of uncomplicated MDD” and “treatment of MDD that is severe or has a partial or limited response to initial treatment.” This change was made to better align with the current body of evidence and clinical practice.

Numerous interventions that did not meet inclusion criteria or had a limited recommendation in the 2016 guideline now are included or have a higher-level recommendation. Among these recommendations:

• Short-term psychodynamic psychotherapy is now recommended as an initial treatment option for individuals with uncomplicated MDD (Recommendation 7)
• Bright light therapy is now recommended for individuals with mild to moderate MDD, regardless of seasonal pattern or seasonal component (Recommendation 26)
• Ketamine or esketamine may be used as treatment options for patients who have not had an adequate response to several pharmacologic trials (Recommendation 19)

The authors wrote, “In addition, considerations regarding psychedelic medications, pharmacogenomics, treatment modalities, and the lack of sufficient information to address specific patient populations highlight areas requiring additional research.”

—Yvette C Terrie, BS, Pharm, R.Ph.

Reference:

McQuaid JR, Buelt A, Capaldi V, et al. 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;10.7326/M22-1603. doi:10.7326/M22-1603