Pharmacologic Treatment of Acute Major Depression and Dysthymia: Clinical Guideline, Part 1

Position Papers2 May 2000Pharmacologic Treatment of Acute Major Depression and Dysthymia: Clinical Guideline, Part 1Vincenza Snow, MD, Steven Lascher, DVM, MPH, and Christel Mottur-Pilson, PhD, for the American College of Physicians-American Society of Internal Medicine*.Vincenza Snow, MD, Steven Lascher, DVM, MPH, and Christel Mottur-Pilson, PhD, for the American College of Physicians-American Society of Internal Medicine*.Author, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-132-9-200005020-00010 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail The numbers in square brackets are cross-references to the numbered sections in the accompanying background paper, "A Systematic Review of Newer Pharmacotherapies for Depression in Adults: Evidence Report Summary," which is part 2 of this guideline (see pages743-756).Major depression and dysthymia are two of the most common and debilitating illnesses. The World Health Organization estimates that worldwide, major depression is the fourth leading cause of loss of disability-adjusted life-years. Major depression is a clinical syndrome lasting at least 2 weeks, during which the patient experiences either depressed mood or anhedonia plus at least five of the following symptoms: depressed ...References1. Mulrow CD, Williams JW Jr, Trivedi M, Chiquette E, Aquilar C, Cornell JE. Treatment of Depression: Newer Pharmacotherapies. Evidence Report/Technology Assessment No. 7. Rockville, MD: Agency for Health Care Policy and Research; February 1999. AHCPR Publication No. 99-E014. www.ahcpr.gov/clinic/depresumm.htm. Google Scholar2. Glass RM. Treating depression as a recurrent or chronic disease [Editorial]. JAMA. 1999;281:83-4. CrossrefMedlineGoogle Scholar3. Depression Guideline Panel. Depression in Primary Care. Volume 2. Treatment of Major Depression. Clinical Practice Guideline No. 5. Rockville, MD: U.S. Department of Health and Human Services; 1993. AHCPR Publication No. 93-0551. Google Scholar4. Physicians' Desk Reference. Montvale, NJ: Medical Economics; 1998. Google Scholar5. Simon GE, VonKorff M, Heiligenstein JH, Revicki DA, Grothaus L, Katon W, et al . Initial antidepressant choice in primary care. Effectiveness and cost of fluoxetine vs tricyclic antidepressants. JAMA. 1996;275:1897-902. CrossrefMedlineGoogle Scholar6. Red Book Update. Montvale, NJ: Medical Economics; 1998. Google Scholar7. Reynolds CF, Frank E, Perel JM, Imber SD, Cornes C, Miller MD, et al . Nortriptyline and interpersonal psychotherapy as maintenance therapies for recurrent major depression: a randomized, controlled trial in patients older than 59 years. JAMA. 1999;281:39-45. CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: For definitions of terms, see Glossary.For other ACP-ASIM Clinical Practice Guidelines, see www.acponline.org/sci-policy/guidelines.This paper, written by Vincenza Snow, MD, Steven Lascher, DVM, MPH, and Christel Mottur-Pilson, PhD, was developed by the Clinical Efficacy Assessment Subcommittee: David C. Dale, MD, Chair; William E. Golden, MD; Robert D. McCartney, MD; Keith W. Michl, MD; Stephen G. Pauker, MD; Sean R. Tunis, MD; Kevin B. Weiss, MD; Preston L. Winters, MD; and John J. Whyte, MD. Approved by the Board of Regents on 17 July 1999.Disclaimer: The authors of this article are responsible for its content, including any clinical or treatment recommendations. No statement in this article should be construed as an official position of the Agency for Healthcare Research and Quality or the U.S. Department of Health and Human Services.Corresponding Author: Customer Service, American College of Physicians-American Society of Internal Medicine, 190 N. Independence Mall West, Philadelphia, PA 19106.Current Author Addresses: Drs. Snow, Lascher, and Mottur-Pilson: Scientific Policy Department, Education Division, American College of Physicians-American Society of Internal Medicine, 190 N. Independence Mall West, Philadelphia, PA 19106. 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