APA Issues New Depression Treatment Guidelines

Oct. 1, 2010— -- The American Psychiatric Association has issued an update to its 10-year-old treatment guidelines for major depression following a yearlong delay during which the group sought to defuse conflict-of-interest problems involving guideline committee members.

The new recommendations cover use of antidepressant medications and psychotherapies, as well as treatments such as electroconvulsive therapy and alternative treatments. The guidelines also address depression during pregnancy and strategies for treatment-resistant depression.

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Among the changes made to the previous set of guidelines is a recommendation to add the use of rating scales to assess type, frequency, and extent of psychiatric symptoms to better tailor the treatments to the needs of the patient. Therapies based on exercise and other healthy behaviors as methods for providing modest improvement of depression symptoms and the strengthening of previous recommendation that maintenance treatment be considered in patients at high risk for recurrence of major depression are other new features of the revised guidelines.

The committee began work in 2005 when the APA and many other medical societies did not forbid guideline authors from serving as consultants to pharmaceutical companies.

Indeed, most of the depression guideline authors, including chairman Dr. Alan Gelenberg of Penn State University in Hershey, Pa., reported extensive relationships with industry. But, following heavy criticism that guideline authors across medicine were too cozy with drug and device companies, the ethics landscape has changed dramatically in recent years.

Gelenberg disclosed consulting relationships with 17 companies; another consulted or served on speakers bureaus for 25. Only one of the panel's seven members reported no industry ties.

"Both the [APA] board and the work group realized that previous policies that emphasized disclosure were not as rigorous as the current climate warranted," according to APA President Dr. Carol Bernstein in a statement.