UTRGV Three Depression Treatment Guidelines Review & The APA Discussion

Discussion Board 3

YOU WILL REALIZED THAT THE OTER STUDENT DID NOT COMPARE THEY SUMMRIZED INSTEAD OF COMPARING.

PLEASE COMPARE THEM ONE VERSUS THE OTHER, THE PROS AND CONS….

PLEASE SEE ATTACHED.

APA with Citation and references.

Review the depression treatment guidelines (APA, VA/DoD, NICE) and compare the recommendations. Which guidelines do you find most useful? Why?

Reply Posts

Read your peers´ posts and respond to at least two of your peers. Compare your answer to that of your classmates and create engaging dialog based on both. Your response should include evidence of review of the course material through proper citations using APA format.

A) Respond to post 1 phips melan

Depression Treatment GuidelinesPost:Depression Treatment GuidelinesAuthor: Melanie PhippsPosted Date:September 25, 2020 10:31 PMStatus:Published

APA Guidelines

The American Psychiatric Association (APA) guideline provided in our week 5 material has a table with the dosing of medications which are effective in treating major depressive disorder (MDD). It also has a table for potential treatments for side effects of antidepressants. The APA suggests pharmacotherapy or depression-focused psychotherapy for patients with mild to moderate depression (American Psychiatric Association, 2010). These two treatments may be provided in combination for individuals with psychosocial or interpersonal problems, intrapsychic conflict, or a co-occurring Axis II disorder (American Psychiatric Association, 2010). Electroconvulsive therapy (ECT) is also recommended for certain patients (American Psychiatric Association, 2010). For severe depression, pharmacotherapy and combination treatment with an antidepressant and depression-focused psychotherapy are recommended, along with ECT (American Psychiatric Association, 2010). However, if the patient has psychotic features, include an antipsychotic medication to the treatment plan (American Psychiatric Association, 2010).

The newer APA guideline found online provides their recommendations in tables, which I find easy to read. According to Table 3, the American Psychiatric Association (2019) recommends offering either psychotherapy (behavioral therapy, cognitive, cognitive-behavioral (CBT), and mindfulness-based cognitive-therapy (MBCT), interpersonal therapy (IPT), psychodynamic therapies, or supportive therapies) or a second-generation antidepressant. If a combination treatment is provided, CBT or IPT plus a second-generation antidepressant are recommended (American Psychiatric Association, 2019). The American Psychiatric Association (2019) also has recommendations for children and adolescents in this guideline.

VA/DoD Guidelines

The VA/DoD guideline has an algorithm to help facilitate clinical decision making for managing MDD. The Department of Veteran Affairs (2016) recommends offering either evidence-based psychotherapy (acceptance and commitment therapy (ACT), behavioral therapy/behavioral activation (BT/BA), CBT, IPT, MBCT, or problem-solving therapy (PST)) or evidence-based pharmacotherapy (selective serotonin reuptake inhibitor (SSRIs) (except fluvoxamine), serotonin-norepinephrine reuptake inhibitor (SNRIs), mirtazapine, or bupropion) for uncomplicated mild to moderate MDD. For patients with severe, chronic, or recurrent MDD, a combination of pharmacotherapy and psychotherapy are recommended for treatment (Department of Veterans Affairs, 2016).

NICE Guidelines

The National Institute for Health and Care Excellence (NICE) has pathways to provide information on depression in an interactive flowchart and a stepped-care model. It includes guidelines for children, young people, adults, and adults with a chronic physical health problem. NICE recommends an antidepressant (normally a SSRI) or high-intensity psychological intervention (CBT, IPT, BA, or behavioral couples therapy) for people with persistent subthreshold depressive symptoms or mild to moderate depression (National Institute for Health and Care Excellence, 2009). For individuals with moderate or severe depression, a combination of antidepressant and high-intensity psychological intervention should be offered (National Institute for Health and Care Excellence, 2009).

Personal Preference

I personally prefer the NICE guidelines due to having the information in an interactive flowchart. I find it to be more user-friendly for me and I have the ability to view the information in mobile or computer mode. To me, the information flows better and I can bounce between information easily rather than having to scroll through pages or referring to the table of contents. However, there are advantages to all the guidelines reviewed.

References

American Psychiatric Association. (2010). Treating major depressive disorder: A quick

reference guide. https://psychiatryonline.org/guidelines

American Psychiatric Association. (2019). Clinical practice guideline for the treatment of

depression across three age cohorts. https://www.apa.org/depression-guideline/guideline…

Department of Veterans Affairs. (2016, February 16). VA/DoD clinical practice guideline for the

management of major depressive disorder. https://www.healthquality.va.gov/guidelines/MH/mdd…

National Institute for Health and Care Excellence. (2009, October 28). Depression in adults:

Recognition and management. https://www.nice.org.uk/guidance/cg90/chapter/Reco…

B) RESPOND 2 TO BEYER

The three treatment guidelines for depression from the American Psychiatric Association (APA), Veterans Affairs/Department of Defense (VA/DoD) and the National Institute for Health and Care Excellence (NICE) have more in common than they do in differences. The VA/DoD is outlined only for adults, specifically the military population. The VA/DoD recommended psychotherapy and psychopharmacotherapeutics as first-line treatment for uncomplicated mild to moderate MDD. The guidelines included medications to avoid but did not specifically advise what selective serotonin reuptake inhibitor (SSRI) or selective serotonin-norepinephrine reuptake inhibitor (SNRI) to use. The VA/DoD recommended only the PHQ to assess for depression. They also included recommendations on the continuation of therapy, monitoring, considerations for specific populations, and chronic, severe, or recurrent MDD (VA/DoD, 2016).

I found the APA guidelines more similar to the VA/DoD guidelines as compared to the NICE guidelines. Unlike the VA/DoD, the APA guidelines included child and adolescent populations. It also provided informative easy to read tables, with evidence-based recommendations for psychotherapy and pharmacotherapy. The VA/DoD and APA included in their guidelines the SSRIs to avoid for first-line therapy of mild to moderate depression. However, the APA did not recommend a named tool to assess for depression as did the VA/DoD (APA, 2019), (VA/DoD, 2016)

The NICE guidelines included adults from 18 years old and older. They focused on providing psychotherapies with consideration of culture and languages. The guidelines did not mention a specific tool to measure depression, similar to APA. For mild persistent depression, NICE recommended psychotherapy and against the use of antidepressants. Upon reassessment, in 4 weeks antidepressants could be considered (NICE, 2018), (APA, 2019).

Between the three guidelines, I considered the VA/DoD and APA the easiest to read and to follow. They both contained convenient tables that outlined the guidelines and recommendations. The VA/DoD contained an algorithm with the guidelines that included identification, assessment and triage, and management. It was a quick assessment tool. Out of the three, I would likely prefer the APA guidelines. The APA guidelines provided not only first-line treatment medications but also the names of alternatives. The APA also provided excellent guidelines for children and adolescents (VA/DoD, 2016), (APA, 2019).

References

American Psychiatric Association. (2019). Clinical practice guideline for the treatment of depression across three age cohorts. Retrieved from: https://www.apa.org/depression-guideline/guideline.pdf

National Institute for Health and Care Excellence. (2018). Depression in adults: Treatment and management. Retrieved from: https://www.nice.org.uk/guidance/GID-CGWAVE0725/do…

Veterans Affairs/Department of Defense. (2016). VA/DoD clinical practice guideline for the management of major depressive disorder. Retrieved from: https://www.healthquality.va.gov/guidelines/MH/mdd/VADoDMDDCPGFINAL82916.pdf