This guideline summarizes the specific approaches to
treatment of individuals with major depressive disorder. It
presupposes that the psychiatrist has diagnosed major depressive
disorder, according to the criteria defined in
DSM-IV-TR, in an adult patient and has evaluated the
patient to identify general medical conditions that may
contribute to the disease process (e.g., hypothyroidism,
pancreatic carcinoma) or complicate its treatment (e.g.,
cardiac disorders). The treatment recommendations that
follow may also have some relevance for patients who
have depressive symptoms on the basis of other syndromes,
such as dysthymic disorder. Because many patients
have co-occurring psychiatric disorders, including
substance use disorders, the psychiatrist should also consider
applicable treatment guidelines for these diagnoses.
When patients experience depressive symptoms in the
context of another disorder and do not meet the diagnostic
criteria for major depressive disorder, the APA practice
guideline pertaining to the primary diagnosis should be
consulted. For patients found to have depressive symptoms
within the context of bipolar disorder, the psychiatrist
should refer to APA’s Practice Guideline for the Treatment of
Patients With Bipolar Disorder (2). Recommendations on
the treatment of depressive disorders in children and adolescents
can be found in the American Academy of Child
and Adolescent Psychiatry’s Practice Parameter for the Assessment
and Treatment of Children and Adolescents With
Depressive Disorders (3).