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Getting depression clinical practice guidelines right: time for change?
Author(s) -
Kuiper S.,
McLean L.,
Fritz K.,
Lampe L.,
Malhi G. S.
Publication year - 2013
Publication title -
acta psychiatrica scandinavica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.849
H-Index - 146
eISSN - 1600-0447
pISSN - 0001-690X
DOI - 10.1111/acps.12176
Subject(s) - chronobiology , depression (economics) , light therapy , mood , context (archaeology) , agomelatine , psychiatry , modalities , psychology , clinical practice , medicine , psychotherapist , clinical psychology , circadian rhythm , antidepressant , neuroscience , family medicine , history , social science , anxiety , archaeology , sociology , economics , macroeconomics
Objective As part of a series of papers [‘Chronobiology of mood disorders’ Malhi & Kuiper. Acta Psychiatr Scand 2013; 128 (Suppl. 444):2–15; and ‘It's time we managed depression: The emerging role of chronobiology’ Malhi et al. Acta Psychiatr Scand 2013; 128 (Suppl. 444):1] examining chronobiology in the context of depression, this article examines recent western clinical practice guidelines ( CPG s) for the treatment of depression with respect to the recommendations they make, in particular as regards chronobiological treatments, and briefly considers the implications of their methodology and approach. Method Five international treatment guidelines, which had been published in the past 5 years, were identified, representing N orth A merican and E uropean views. Chosen guidelines were reviewed by the authors, and the relevant recommendations were distributed for discussion and subsequent synthesis. Results Most current guidelines do not address chronobiology in detail. Chronotherapeutic recommendations are tentative, although agomelatine is considered as an option for major depression and bright light therapy for seasonal affective disorder. Sleep deprivation is not routinely recommended. Conclusion Recommendations are limited by the lack of reliable therapeutic markers for chronotherapeutics. Current evidence supports use of light therapy in seasonal depression, but in non‐seasonal depression there is insufficient evidence to support reliance on chronotherapeutics over existing treatment modalities.