American Psychological Association (APA) outlines evidence based practice guidelines and recommendation for assessment and treatment of major depressive disorder (depression) intended to enable psychiatrists make informed clinical decision based on strategies that are systematically developed. VADoD prescribes critical decision points and comprehensive recommendations in management of major depressive disorder (US department of Veteran Affairs, 2016). The guidelines incorporate information meant to improve patient outcomes throughout the DoD and VA healthcare systems. NICE depression guidelines identifies advice, guidance, quality standards and pathways for managing major depressive disorder in primary and secondary care among adults aged 18 years and above.
I find the clinical depression guidelines suggested by the National Institute for Clinical Excellence (NICE) most useful. NICE major depressive disorder guidelines outweigh other recommendations by APA and VA/DoD because of how comprehensive they are in promoting recognition and treatment for people diagnosed with depression ( National Institute for Health and Care Excellence, n.d) . NICE guidelines are exhaustive in comparison with other guidelines since they touch on care of all people with depression, complex and severe depression, enhanced care for depression and stepped care. Additionally NICE guidelines address the choice of treatment based on personal characteristics and depression subtypes, relapse prevention and sequencing treatments. NICE major depressive guidelines are the most useful since their recommendations have been revised thereby making the entire package up to date. NICE guidelines are developed based on the evidence that is best available. The recommendations have been compiled by experts, carers, testimonies from practitioners, the public and people using NICE treatment services ( National Institute for Health and Care Excellence, n.d) . NICE depression treatment guidelines have put into consideration individual needs, patient values and preferences of populations that use their services.
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I find the VA/DoD depression treatment guidelines least useful relative to APA and NICE recommendations. The scope of the VA/DoD is limited due to its failure to recommend clinical guidelines for the treatment of co-occurring disorders. The guidelines do not cover control of MDD in adolescents or children. The guidelines are also the least useful as they do not address control measures for depressive disorders that are unspecified such as persistent depressive disorder, and other major depressive disorders pinpointed in DSM-5. The VA/DoD are only specific to the Veterans Health Affairs but not to the general public. The depression recommendations provided are only meant to facilitate activities and initiatives of the military health systems and department of defense DoD. The depression guidelines are least useful as they only target adults in the VA/DoD populations but not ordinary civilians.
Differences
APA and NICE guidelines comprehensively address the issue of acute management of rapid cycling and gives recommendations that LI, Valp or a combination can be used in treatment of depression. Contrary, VA/DoD major depressive disorder guidelines do not comment on the issue of acute management of rapid cycling. In addition, APA and NICE differ in respect to treatment of manic episodes ( American Psychological Association, n.d) . While APA acknowledges the essence of mood stabilizers such as Valproate as first line management of the condition, NICE guidelines prefer using antipsychotics drugs for example Risperidone or Olanzapine. Unlike APA guidelines, NICE addresses the utility of Vapl and Li as first line in relation to Risp or Olaz. Contrary to VA/DoD and APA, NICE discourages the use of Li as first line and instead recommends a combined use of Specific Serotonin Reuptake Inhibitors with Vapl or Li.
APA recommends using Lamotrigine as first line in the treatment and prevention of depressive episodes whereas NICE states that Lamotrigine ought to be used as second line in management of depressive episodes (Saddichha & Chaturvedi, 2014). Country to APA, VA/DoD and NICE recommends LI and Valp in maintenance of depressive episodes. On the span of pharmacotherapy, only APA addresses the length of time on continuation. Unlike APA guidelines and VA/DoD, only NICE framework favors the use of specific treatments for management of atypical depression. NICE recommends MAOIs or SSRIs as first line prophylaxis drugs which are discouraged by APA and VA/DoD. Only NICE recommendations prefer application of specific prophylaxis for melancholic depression (Saddichha & Chaturvedi, 2014). Others prefer using drugs such as Venlafaxine or Paroxetine as first line treatment drugs for maintenance of melancholic depression. NICE and APA differ on the pharmacotherapy duration as APA recommends up to 12 weeks and 9 months while NICE has no specific guideline on acute management of depression ( American Psychological Association, n.d) . NICE and APA guidelines are meant to be used by the general civilian populations while VA/DoD targets VA and DoD cohorts only.
Similarities
All the three guidelines, APA, VA/DoD, NICE recommend the use of Lithium and Valp in treatment of prophylaxis or manic episodes. The guidelines share a similarity on the management of acute depressive episodes. According to Saddichha and Chaturvedi (2014), APA, VA/DoD and NICE agree on the usage of Li as a first line drug. Regarding psychosocial management, APA, VA/DoD, NICE support application of cognitive behavior therapy or family focused therapy. The three frameworks favor continued use of the same antidepressant in treatment of acute and depressive episodes. On psychosocial management, APA, VA/DoD, NICE recommend the use of interpersonal therapy (IPT) and CBT. The three frameworks support adoption of either FGAs or SGAs as standard drug regime in treatment of acute psychotic episodes. The guidelines also agree on the contionous usage of the same antipsychotic drugs in management of acute depressive episodes.
As a psychiatrist practitioner, I would use APA recommendations as a first line reference tool since the framework has a clear and exhaustive guide for healthcare professionals on the prophylaxis and management guidelines of Major Depressive Disorder.
References
American Psychological Association (n.d). APA offers new guidance for treating depression, https://www.apa.org/monitor/2019/09/ce-corner-depression
National Institute for Health and Care Excellence (n.d). How we develop NICE guidelines, https://www.nice.org.uk/about/what-we-do/our-programmes/nice-guidance/nice-guidelines/how-we-develop-nice-guidelines
Saddichha, S., & Chaturvedi, S. K. (2014). Clinical practice guidelines in psychiatry: more confusion than clarity? A critical review and recommendation of a unified guideline. ISRN psychiatry , 2014 .
US department of Veteran Affairs (2016). VA/DoD Clinical Practice Guidelines, https://www.healthquality.va.gov/guidelines/MH/mdd/ .
