A clinical practice guideline summary on the treatment and management of major depressive disorder m

This prediction has received support in a case studies and open trials with a variety of diagnoses. Expanding the standard protocols Shapiro, additional applications have been developed in clinical practice by experts and consultants in a number of specialty areas. As with all treatments for most of these disorders, little controlled research has been conducted, a state of affairs evident in an evaluation report by a task force set in motion by the Clinical Division of the American Psychological Association Chambless, Baker, Baucom, Beutler, Calhoun, Crits-Christoph, et al.

A clinical practice guideline summary on the treatment and management of major depressive disorder m

Phantom pain associated with spinal cord injury Restless legs syndrome Stroke treatment e. Background Transcranial magnetic stimulation TMS is a non-invasive method of induction of a focal current in the brain and transient modulation of the function of the targeted cerebral cortex. This procedure entails placement of an electromagnetic coil on the scalp; high-intensity electrical current is rapidly turned on and off in the coil through the discharge of capacitors.

Depending on stimulation parameters frequency, intensity, pulse duration, stimulation siterepetitive TMS rTMS to specific cortical regions can either increase or decrease the excitability of the affected brain structures.

Transcranial magnetic stimulation has been investigated in the treatment of various psychiatric disorders, especially depression.


This procedure is usually carried out in an outpatient setting. In contrast to electroconvulsive therapy, TMS does not require anesthesia or analgesia.

Furthermore, it does not affect memory and usually does not cause seizures.

Using data from the AHRQ report, the Institute for Clinical and Economic Review (ICER, ) conducted a cost-effectiveness modeling study, assuming that transcranial electrical stimulation and electroconvulsive therapy have equivalent efficacy. Pediatricians have an important role not only in early recognition and evaluation of autism spectrum disorders but also in chronic management of these disorders. The primary goals of treatment are to maximize the child's ultimate functional independence and quality of life by minimizing the core autism spectrum disorder features, facilitating development and learning, promoting socialization. Mar 18,  · Summary. This guideline provides recommendations for primary care clinicians who are prescribing opioids for chronic pain outside of active cancer treatment.

However, the available peer-reviewed medical literature has not established the effectiveness of rTMS in the treatment of psychiatric disorders other than major depression.

In addition, more research is needed to ascertain the roles of various stimulation parameters of rTMS for its optimal outcome as well as its long-term effectiveness in the treatment of psychiatric disorders.

Depression Martin et al conducted a systematic review of randomized controlled trials that compared rTMS with sham in patients with depression. The authors concluded that current trials are of low quality and provide insufficient evidence to support the use of rTMS in the treatment of depression.

This is in accordance with the observations of Fitzgerald and colleagues who noted that TMS has a considerable role in neuropsychiatric research.


It appears to have considerable potential as a therapeutic tool in depression, and perhaps a role in several other disorders, although widespread application requires larger trials and establishment of sustained response, as well as Gershon et al who stated that TMS shows promise as a novel anti-depressant treatment.

Systematic and large-scale studies are needed to identify patient populations most likely to benefit and treatment parameters most likely to produce success.

One patient was lost to follow-up at end of treatment and another 8 at 6 months. However, HRSD scores did not differ between groups at 6 months.

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Improvement in subjective reports of side-effects following ECT correlated with anti-depressant response. The report noted that analysis of cost-effectiveness acceptability curves demonstrated that rTMS has very low probability of being more cost-effective than ECT.

A treatment course usually consists of 6 weeks of min sessions 5 days a week. It was a study fraught with statistical questions that concerned the agency's own scientific advisers. For a more clear answer, the National Institutes of Health has an independent study under way that tracks patients Associated Press, Randomized, controlled studies of rTMS compared to sham treatment have produced conflicting results O'Reardon et al, ; Avery et al, ; Mogg et al, Active TMS was well-tolerated with a low drop-out rate for adverse events 4.

The authors concluded that TMS was effective in treating major depression with minimal side effects reported. Further, at 6 weeks, 36 Furthermore, continued active TMS provided additional benefit to some patients who failed to respond to 4 weeks of treatment, suggesting that longer courses of treatment may confer additional therapeutic benefit.

On the other hand, Mogg and co-workers noted that the effectiveness of rTMS for major depression is unclear. Secondary outcomes included mood self-ratings on Beck Depression Inventory-II and visual analog mood scales, Brief Psychiatric Rating Scale score, and both self-reported and observer-rated cognitive changes.

Patients had 6-week and 4-month follow-ups. Blinding was difficult to maintain for both patients and raters. A total of 16 medication-free patients with refractory MDD diagnosed according to DSM-IV who initially had clinically significant anti-depressant responses to a day course of Hz rTMS were consecutively admitted to the protocol from to and were followed for 4 years.

The cohort was studied during a total of 64 episodes of depressive relapse. Safety was assessed by serial neurological examinations and neuropsychological evaluations. Despite the lack of adjuvant anti-depressant medication, the mean interval between treatment courses was approximately 5 months, and the medication-free period ranged from 26 to 43 months.

Transcranial magnetic stimulation was well-tolerated, and evaluations regarding the safety of the repeated applications of rTMS revealed no findings of concern.

A clinical practice guideline summary on the treatment and management of major depressive disorder m

The authors concluded that repeated rTMS applications have demonstrated a reproducible anti-depressant effect in patients with refractory depression who initially showed a clinically significant benefit.

The duration of effect varied across patients, but benefits were sustained for a mean of nearly 5 months.Number: Policy. Aetna considers low-level infrared light (infrared therapy, Anodyne Therapy System) experimental and investigational for the treatment of the following indications because of insufficient evidence regarding the effectiveness of infrared therapy for .

Federal Bureau of Prisons Management of Major Depressive Disorder Clinical Guidance May i • Changes were made in accordance with the Practice Guideline for Treatment of Patients with Major Federal Bureau of Prisons Management of Major Depressive Disorder.

Depression Treatment and Management; Bipolar Disorder; Co-Occurring Disorders. Eating Disorders; Clinical Practice Review for Major Depressive Disorder. Diagnostic and Statistical Manual of Mental Disorders (DSM-5) For diagnostic criteria and codes, visit the DSM-5 website; requires subscription and login.

Major Depressive Disorder (MDD). Summary Of Clinical Practice Guidelines: APA Treatment Guidelines – Major Depressive Disorder (MDD) Resource | March 30, Psychiatrists Target Population: Adults with major depressive disorder (MDD) Guideline Objectives: To summarize the specific approaches to treatment of individuals with major depressive disorder.

A clinical practice guideline summary on the treatment and management of major depressive disorder m

Summary Of . Evidence-based research provides the basis for sound clinical practice guidelines and recommendations. The database of guidelines available from the National Guideline Clearinghouse and the recommendations of the U.S.

Preventive Services Task Force are especially useful. Post-Award Grant Management. AHRQ Grantee Profiles; Getting. The Work Group on Major Depressive Disorder reports APA makes this practice guideline freely available to promote its dissemination and use; however, copyright protections are enforced in full.

No part of this guideline may the treatment of patients with major depressive disorder. The and.

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