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Psychiatrists revive depression guidelines

by Michael Woodhead  

Exasperated at the general indifference to guidelines for mood disorders, psychiatrists have switched tack and developed a series of individualised recommendations for managing patients with depression and bipolar disorder.  

Professor Gin Malhi of the Royal North Shore Hospital in Sydney says doctors have tended to ignore evidence-based guidelines for depression because they already have their own internalised  ‘mindlines’ shaped by experience and feedback from peers and patients as well as evidence.  

Writing in the journal Acta Psychiatrica Scandinavica (119:5-7) he says doctors have also become wary of guidelines because they are increasingly being applied broadly to promote consistency and quality in clinical services.  

To try promote the uptake of the latest evidence, Professor Malhi and colleagues have developed a series of clinical recommendations in a new format that gives advice for specific scenarios, but which allows for ‘clinical wisdom’ and which should be tailored to the individual’s circumstances.  

The advice includes recommendations for psychological strategies to be given greater consideration in patients with depression, and for treatment to be shaped by the phase of a patient’s depression. The recommendations include a chart of how different antidepressants may help in different subsets of depression.  

However, the group emphasise that their recommendations “do not represent a reference standard of care in medico-legal proceedings.”   

For bipolar disorder they say one of the key issues for patients to receive treatment as quickly as possible, and they note that drugs such as lamotrigine, valproate and atypical antipsychotics may have a role as well as lithium.


17 April 2009
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Latest Comments

  • I have tried to wade through the viscosity of that 2 volume guide to psychiatric management published by the NSW health department a few years ago. Like all such publications, it pre-supposes no knowledge and bogs down in "ab initio" definition, and endles crap about goals, strategies, and counselling. Lists of overlapping symptoms and blurring of the edges of diagnosis such as there seems no likelhood of a useful diagnosis ever being made.

    Want we need is a table with symptoms, presentations and diagnositc clues on the abscissa and medication be they antidepressants, antipsychotics etc. on the ordinate. With warning and cross interactions and side effects on the bottom.

    This could probably be wrapped up in a three page "ready reckoner" to leave on your desk. It may not be perfect but it has got to be a lot more useful that the quagmire that is presented in reference literature on the management of psychiatric illness now.

    I went to a lecture once on "what antidepressant to use when" (by a shrink) and the waffle that engulfed this presentation left me totally confused and none the wiser.

    One thing I remember was that the shrink was dead against Champix.

    Perhaps it is not possible to define a logical pattern of use of psychotropic drugs, perhaps it is just try one and if it doesn't work try the next. Maybe an alphabetical approach might be best,at least then with mobile patients you won't cover the same ground again, you would just move on down the list.

    I tried to access the website indicated above but you have got to pay for it and I am too lousy to do that.

    I would like a drug company to prepare something useful like the above "table" and hand it out over a $37 dinner. I might even occasionally prescribe their product if it is included on the list.

    Lee Simes GP Nowra

    Posted by Lee Simes 17/04/2009 5:53:54 PM

  • Seventy-one pages of guidelines - that's useful!

    I'll have a squiz in between patients this afternoon...

    Posted by Bill Walton 17/04/2009 8:55:03 PM

  • Too many drugs its unatural

    Posted by Roland 23/04/2009 10:00:34 PM

  • very interesting and important

    Posted by Stuart Bayley 14/05/2009 7:30:53 PM

  • Too many drugs these days. Look at alphastim.com.au for an evidenced based alternative

    Posted by Roy 19/05/2009 11:39:25 AM

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