Clinical Practice Guidelines in Psychiatry: More Confusion Than Clarity? A Critical Review and Recommendation of a Unified Guideline
Table 2
Comparison of guidelines and unified guideline for the management of depressive disorder.
APA
Canadian
NICE
Maudsley
Unified
Depressive episode-acute treatment
SSRI/SNRI/Bupropion/ Mirtazapine
Venlafaxine/SSRIs/novel ADs
SSRIs/SNRIs
SSRIs
SSRIs/SNRIs
Prophylaxis of recurrent depressive disorder
To continue same antidepressant as acute treatment
To continue same antidepressant as acute treatment
To continue same antidepressant as acute treatment
SRT/Citalopram/Reboxetine/ Venlafaxine
Continue SSRIs/SNRIs
Dysthymia
No specific guidelines
SSRIs
No specific guidelines
No specific guidelines
SSRIs/SNRIs
Depression with atypical features
No specific guidelines
FXT/SRT/Moclobemide
SSRIs/Phenelzine
No specific guidelines
SSRIs/MAOIs
Depression with Melancholia
No specific guidelines
PXT/Venlafaxine
PXT/Venla
No specific guidelines
PXT/Venlafaxine
Seasonal depression
No specific guidelines
Bright light therapy/FXT
FXT or bright light therapy
No specific guidelines
FXT/bright light therapy
Anxious depression
No specific guidelines
PXT/SRT/Mirtaz/Venlafaxine
No specific guidelines
No specific guidelines
SSRIs/SNRIs
Duration
Acute phase: 6 to 12 weeks Continuation phase: 6–9 months Maintenance phase: 1 to 2 years to lifetime
Acute phase: 8 to 12 weeks Continuation phase: 4–6 months Maintenance phase: 1 to 2 years to lifetime
No mention of duration of treatment of acute episode Long term treatment for at least 2 years after an episode and up to 5 years in case of other risk factors
Long term treatment for 9 months for first episode and up to 2 years for subsequent episodes
Acute phase: up to 12 weeks Continuation phase: up to 9 months Maintenance phase: 2 years for 1st and 5 years to lifetime for subsequent episodes
