The 2020 update of the Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for mood disorders provides a new framework for managing depressive disorders that moves beyond the stepped care approach. This framework is based around three key components: actions, such as lifestyle modification and patient education; choices in pharmacological treatment that include the patient’s preferences; and potential alternative treatments.
- Attending to lifestyle factors (sleep hygiene, diet, exercise and alcohol and substance misuse) is a necessary first step in the management of major depression.
- Psychological treatments, such as cognitive behaviour therapy (CBT), interpersonal psychotherapy and problem solving therapy, are recommended for all patients with depression.
- Digital (online) therapies and therapies delivered via telehealth are efficacious and should be offered to those who are unable to access face-to-face therapy.
- Advantages of digital therapies include accessibility, convenience and fidelity to the treatment model (usually CBT). However, these treatments are not suited to everyone.
- Choice of antidepressant medications requires a balance of efficacy with tolerability and can be guided by the patient’s symptom profile.
- Electroconvulsive therapy is the treatment of choice for people with severe depression and those who do not respond to antidepressant medications.