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Medicine and Nonmedicine Options for the Treatment of Adults With Major Depressive Disorder FREE

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The full report is titled “Nonpharmacologic Versus Pharmacologic Treatment of Adult Patients With Major Depressive Disorder: A Clinical Practice Guideline From the American College of Physicians.” The authors are A. Qaseem, M.J. Barry, and D. Kansagara, for the Clinical Guidelines Committee of the American College of Physicians.

This article was published at www.annals.org on 9 February 2016.


Summaries for Patients are a service provided by Annals and the ACP Center for Patient Partnership in Healthcare to help patients better understand the complicated and often mystifying language of modern medicine.

Summaries for Patients are presented for informational purposes only. These summaries are not a substitute for advice from your own medical provider. If you have questions about this material, or need medical advice about your own health or situation, please contact your physician. The summaries may be reproduced for not-for-profit educational purposes only. Any other uses must be approved by the American College of Physicians.


Ann Intern Med. 2016;164(5):I-18. doi:10.7326/P16-9010
© 2016 American College of Physicians
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9 22016.

What is major depressive disorder?

Major depressive disorder (MDD) is a common condition in adults. It can cause sadness; loss of interest in activities; and changes in weight, appetite, and sleep. People with MDD may have trouble concentrating and making decisions. Also, MDD can cause feelings of guilt and thoughts of death or suicide.

How is MDD treated?

There are many options for treating MDD. Treatment can include medicine and nonmedicine options. It may also include a combination of both.

Antidepressant medicines: These medicines work in your brain to help improve symptoms.

Talk therapy: Talk therapies can help patients learn how to change negative thoughts or behaviors (cognitive behavioral therapy), how to deal with relationship issues (interpersonal therapy), or how past experiences can affect current feelings (psychodynamic therapy).

Alternative treatments: These can involve acupuncture, meditation, and yoga. Other options include supplements, such as omega-3 fatty acids and St. John's wort.

What are the benefits and harms of MDD treatments?

Treatments for MDD can help patients feel better and return to their regular routines.

•Antidepressant medicines are prescribed by a doctor. These medicines can be very helpful in improving MDD symptoms. It may take a few weeks before medicines take full effect. They may also cause side effects, such as constipation, diarrhea, dizziness, headache, sleep changes, nausea, and sexual side effects.

•Talk therapy can take time before symptoms start to improve. Side effects from talk therapy are very rare. Talk therapies can sometimes be expensive, depending on how often you go and what type of insurance you have.

•Alternative treatments may help some people to feel better.

•St. John's wort can help with MDD but may also cause upset stomach, dizziness, and tiredness. It is important to note that St. John's wort is not regulated like prescription medicines to ensure their content. Like other drugs, it may interact with other medicines you are taking.

Who developed these recommendations?

The American College of Physicians (ACP) developed guidelines for the treatment of MDD. Members of ACP are internists—physicians who specialize in the care of adults.

What did the authors find?

The authors looked at research that compared different treatment options for adults with MDD. The authors found that both talk therapy and antidepressant medicines were equally effective in treating MDD. St. John's wort may be as effective as antidepressants and talk therapy. However, because St. John's wort is not regulated in the United States, talk to your doctor before taking it. Other alternative treatments may not be as effective as antidepressant medicines or talk therapy.

What does ACP recommend that patients and doctors do?

The ACP suggests that clinicians choose between either antidepressant medicines or cognitive behavioral therapy to treat patients with MDD. The clinician and patient should make the decision together after discussing different factors, such as

•How well the treatment works

•Possible side effects

•Costs

•Convenience of the treatment

•What the patient prefers.

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