The American College of Physicians Living Guideline on Depression: A Step Forward, but Gaps Remain
Bibliographic record
Abstract
EditorialsFebruary 2023The American College of Physicians Living Guideline on Depression: A Step Forward, but Gaps RemainMiriam Shuchman, MD and Elia Abi-Jaoude, MSc, MD, PhDMiriam Shuchman, MDDepartment of Psychiatry, University of Toronto, Toronto, Ontario, CanadaSearch for more papers by this author and Elia Abi-Jaoude, MSc, MD, PhDDepartment of Psychiatry, University of Toronto, Department of Psychiatry, The Hospital for Sick Children, and Department of Psychiatry, University Health Network, Toronto, Ontario, CanadaSearch for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/M22-3701 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail “Depression is so exhausting. It takes up so much of your consciousness. It is so long-term, not something that you quickly medicate and then you're over it.” So wrote Andrew Solomon in an article about The Noonday Demon: An Atlas of Depression, his 2001 book that won the National Book Award (1).What are the options for clinicians to consider when a patient presents with depression, with dysfunction at the level of major depressive disorder as defined in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5)? This is a very common question given that depression affects about ...References1. Solomon A. Depression, too, is a thing with feathers. 1 January 2008. Accessed at https://andrewsolomon.com/articles/depression-too-is-a-thing-with-feathers on 22 December 2022. Google Scholar2. Qaseem A, Owens DK, Etxeandia-Ikobaltzeta I, et al; Clinical Guidelines Committee of the American College of Physicians. Nonpharmacologic and pharmacologic treatments of adults in the acute phase of major depressive disorder: a living clinical guideline from the American College of Physicians. Ann Intern Med. 2023;176:239-252. doi:10.7326/M22-2056 LinkGoogle Scholar3. World Health Organization. Mental Health and COVID-19: Early evidence of the pandemic's impact: Scientific brief, 2 March 2022. Accessed at www.who.int/publications/i/item/WHO-2019-nCoV-Sci_Brief-Mental_health-2022.1 on 22 December 2022. Google Scholar4. American Psychiatric Association. Practice Guideline for the Treatment of Patients With Major Depressive Disorder. Third Edition. 2010. Accessed at https://psychiatryonline.org/guidelines on 22 December 2022. Google Scholar5. Kennedy SH, Lam RW, McIntyre RS, et al; CANMAT Depression Work Group. Canadian Network for Mood and Anxiety Treatments (CANMAT) 2016 clinical guidelines for the management of adults with major depressive disorder: Section 3. Pharmacological treatments. Can J Psychiatry. 2016;61:540-60. [PMID: 27486148] doi:10.1177/0706743716659417 CrossrefMedlineGoogle Scholar6. Institute of Medicine. Clinical Practice Guidelines We Can Trust. National Academies Pr; 2011. doi:10.17226/13058 CrossrefGoogle Scholar7. Ghaemi SN. Why antidepressants are not antidepressants: STEP-BD, STAR*D, and the return of neurotic depression. Bipolar Disord. 2008;10:957-68. [PMID: 19594510] doi:10.1111/j.1399-5618.2008.00639.x CrossrefMedlineGoogle Scholar8. National Institute for Health and Care Excellence. Depression in adults: treatment and management. NICE guideline [NG222]. 29 June 2022. Accessed at www.nice.org.uk/guidance/ng222 on 22 December 2022. Google Scholar9. Carey B, Gebeloff R. Many people taking antidepressants discover they cannot quit. The New York Times. 7 April 2018. Accessed at www.nytimes.com/2018/04/07/health/antidepressants-withdrawal-prozac-cymbalta.html on 22 December 2022. Google Scholar10. Massabki I, Abi-Jaoude E. Selective serotonin reuptake inhibitor ‘discontinuation syndrome’ or withdrawal. Br J Psychiatry. 2021;218:168-71. [PMID: 31902371] doi:10.1192/bjp.2019.269 CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: Department of Psychiatry, University of Toronto, Toronto, Ontario, CanadaDepartment of Psychiatry, University of Toronto, Department of Psychiatry, The Hospital for Sick Children, and Department of Psychiatry, University Health Network, Toronto, Ontario, CanadaDisclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M22-3701.Corresponding Author: Miriam Shuchman, MD, UTSC Health & Wellness Centre, 1265 Military Trail, Toronto, ON M1C 1A4, Canada; e-mail, m.[email protected]ca.This article was published at Annals.org on 24 January 2023. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoNonpharmacologic and Pharmacologic Treatments of Adults in the Acute Phase of Major Depressive Disorder: A Living Clinical Guideline From the American College of Physicians Amir Qaseem , Douglas K. Owens , Itziar Etxeandia-Ikobaltzeta , Janice Tufte , J. Thomas Cross Jr. , Timothy J. Wilt , and Metrics Current IssueFebruary 2023Volume 176, Issue 2Page: 280-281KeywordsAntidepressantsCognitive behavior therapyConflicts of interestPsychiatry and mental healthTreatment guidelines ePublished: 24 January 2023 Issue Published: February 2023 Copyright & PermissionsCopyright © 2023 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.015 | 0.067 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.003 | 0.003 |
| Bibliometrics | 0.005 | 0.003 |
| Science and technology studies | 0.003 | 0.003 |
| Scholarly communication | 0.007 | 0.008 |
| Open science | 0.004 | 0.003 |
| Research integrity | 0.021 | 0.026 |
| Insufficient payload (model declined to judge) | 0.017 | 0.019 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".