• University of Michigan Health System. Depression. Ann Arbor (MI): University of Michigan Health System; 2005 Oct. 20 p. [3 references]

This is the current release of the guideline.

This guideline updates a previous version: University of Michigan Health System. Depression. Ann Arbor (MI): University of Michigan Health System; 2004 May. 21 p.

Note from the National Guideline Clearinghouse (NGC): The following key points summarize the content of the guideline. Refer to the original guideline document for additional information. The levels of evidence [A-D] are defined at the end of the "Major Recommendations" field.

Diagnosis

Depressed patients frequently present with somatic complaints to their primary care doctor rather than complaining of depressed mood [C].

Treatment

Mild depression can be effectively treated with either medication or psychotherapy. Moderate to severe depression may require an approach combining medication and psychotherapy [A].

• Drug treatment. Fifty to sixty-five percent (50-65%) of patients respond to the first antidepressant [A]. No particular antidepressant agent is superior to another in efficacy or time to response. Choice can be guided by matching patients' symptoms to side effect profile, presence of medical and psychiatric comorbidity, and prior response [A]. Relative costs can also be considered (e.g., generics). University of Michigan Health System (UMHS) preferred agents are Fluoxetine (generic) and citalopram (Celexa®). Patients treated with antidepressants should be closely observed for possible worsening of depression or suicidality, especially at the beginning of therapy or when the dose increases or decreases [C].
• Frequent initial visits. Patients require frequent visits early in treatment to assess response to intervention, suicidal ideation, side effects, and psychosocial support systems [D].
• Continuation therapy. Continuation therapy (9-12 months after acute symptoms resolve) decreases the incidence of relapse of major depression [A]. Long term maintenance or life-time drug therapy should be considered for selected patients based on their history of relapse and other clinical features [B].
• Education/support. Patient education and support are essential. Social stigma and patient resistance to the diagnosis of depression continue to be a problem [D].

Definitions:

Levels of Evidence

1. Randomized controlled trials
2. Controlled trials, no randomization
3. Observational trials
4. Opinion of expert panel

An algorithm is provided in the original guideline document for an overview of treatment for depression.

The type of supporting evidence is identified and graded for each recommendation (see "Major Recommendations").

Conclusions were based on prospective randomized clinical trials (RCTs) if available, to the exclusion of other data; if RCTs were not available, observational studies were admitted to consideration. If no such data were available for a given link in the problem formulation, expert opinion was used to estimate effect size.

• University of Michigan Health System. Depression. Ann Arbor (MI): University of Michigan Health System; 2005 Oct. 20 p. [3 references]

Not applicable: The guideline was not adapted from another source.

1998 Jun (revised 2005 Oct)

University of Michigan Health System - Academic Institution

Internal funding for University of Michigan Health System (UMHS) guidelines is provided by the Office of Clinical Affairs. No external funds are used.

Depression Guideline Team

Team Leaders: Thomas L. Schwenk, MD, Family Medicine; Linda B. Terrell, MD, General Medicine

Team Members: R. Van Harrison, PhD, Medical Education; Elizabeth M. Shadigian, MD, Obstetrics & Gynecology; Marcia A. Valenstein, MD, Psychiatry

Guidelines Oversight Team: Connie J. Standiford, MD; Lee A. Green, MD, MPH; R. Van Harrison, PhD

The University of Michigan Health System endorses the Guidelines of the Association of American Medical Colleges and the Standards of the Accreditation Council for Continuing Medical Education that the individuals who present educational activities disclose significant relationships with commercial companies whose products or services are discussed. Disclosure of a relationship is not intended to suggest bias in the information presented, but is made to provide readers with information that might be of potential importance to their evaluation of the information

Team Member; Relationship; Company

Thomas Schwenk, MD (none)
Linda Terrell, MD (none)
Van Harrison, PhD (none)
Elizabeth Shadigian, MD (none)
Marcia Valenstein, MD, Research Grant, Pfizer

This is the current release of the guideline.

This guideline updates a previous version: University of Michigan Health System. Depression. Ann Arbor (MI): University of Michigan Health System; 2004 May. 21 p.

None available

This summary was completed by ECRI on May 20, 1999. The information was verified by the guideline developer on June 17, 1999. This NGC summary was updated by ECRI on October 12, 2004. The updated information was verified by the guideline developer on October 22, 2004. This summary was updated by ECRI on August 15, 2005, following the U.S. Food and Drug Administration advisory on antidepressant medications. This summary was updated by ECRI on October 3, 2005, following the U.S. Food and Drug Administration advisory on Paxil (paroxetine). This summary was updated by ECRI on October 20, 2005, following the U.S. Food and Drug Administration advisory on Cymbalta (duloxetine hydrochloride). This NGC summary was updated by ECRI on December 16, 2005. This summary was updated by ECRI on May 31, 2006 following the U.S. Food and Drug Administration advisory on Paxil (paroxetine hydrochloride). This summary was updated by ECRI on November 22, 2006, following the FDA advisory on Effexor (venlafaxine HCl). This summary was updated by ECRI Institute on November 9, 2007, following the U.S. Food and Drug Administration advisory on Antidepressant drugs.

This NGC summary is based on the original guideline, which is copyrighted by the University of Michigan Health System (UMHS).