Document Detail

Unipolar depression: diagnostic and therapeutic recommendations from the current S3/National Clinical Practice Guideline.
MedLine Citation:
PMID:  21031129     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Depressive disorders are among the most common illnesses and reasons for obtaining health care. Their diagnosis and treatment are still in need of improvement. In Germany, a new S3/National Clinical Practice Guideline has been developed for this purpose.
METHODS: The existing guidelines on unipolar depression from Germany and other countries were synoptically compared and supplemented with systematic literature searches. After 14 consensus conferences, a total of 107 evidence-based recommendations were issued.
RESULTS: Unipolar depression should be diagnosed in accordance with ICD-10 criteria. Screening questionnaires are useful aids to diagnostic classification. When a treatment is chosen, shared decision-making with the patient is essential. Mild depressive episodes can be treated initially by watchful waiting for 14 days. For moderate depressive episodes, pharmacotherapy and psychotherapy are equally effective treatment options. For severe depression, a combination of pharmacotherapy and psychotherapy is recommended. If 4 to 6 weeks of acute therapy are insufficiently effective, lithium augmentation is recommended, rather than combination antidepressant therapy or a switch to another antidepressant. After remission, maintenance therapy should be continued for 4 to 9 months. In recurrent depression, pharmacotherapy and/or psychotherapy, where appropriate, should be continued for at least two years. Specific recommendations are given for patients who have somatic or mental comorbidities or are acutely suicidal, and recommendations are also given for coordination of care.
CONCLUSION: This guideline is a comprehensive set of evidence- and consensus-based recommendations for the diagnosis and treatment of unipolar depression. An improvement in the care of patients with unipolar depression will require broad implementation of the guideline, both in the inpatient and outpatient setting.
Martin Härter; Christian Klesse; Isaac Bermejo; Frank Schneider; Mathias Berger
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Publication Detail:
Type:  Journal Article     Date:  2010-10-08
Journal Detail:
Title:  Deutsches Ärzteblatt international     Volume:  107     ISSN:  1866-0452     ISO Abbreviation:  Dtsch Arztebl Int     Publication Date:  2010 Oct 
Date Detail:
Created Date:  2010-10-29     Completed Date:  2011-03-08     Revised Date:  2013-07-03    
Medline Journal Info:
Nlm Unique ID:  101475967     Medline TA:  Dtsch Arztebl Int     Country:  Germany    
Other Details:
Languages:  eng     Pagination:  700-8     Citation Subset:  IM    
Institut und Poliklinik für Medizinische Psychologie, Universi -tätsklinikum Hamburg-Eppendorf, Hamburg, Germany.
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MeSH Terms
Depressive Disorder / diagnosis*,  therapy*
Neurology / standards*
Practice Guidelines as Topic*
Psychotherapy / standards*

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