Version October 2024
This algorithm outlines an approach to the initial management of MDD. It should be used in conjunction with UpToDate content on the diagnosis and initial management of MDD.
When assessing the level of depression severity to determine treatment selection, clinicians should consider degree of functional impairment and the duration, trajectory, and intensity of symptoms as well as the number of depressive symptoms and/or PHQ-9 score.
For details on depressive symptoms, use of the PHQ-9, and how to determine symptom severity, please refer to related UpToDate content.MDD: major depressive disorder; PHQ-9: 9-item Patient Health Questionnaire; SNRI: serotonin-norepinephrine reuptake inhibitor; SSRI: selective serotonin reuptake inhibitor.
* The number and frequency of symptoms is a starting point for assessing episode severity. The level of functional impairment and symptom duration and trajectory may further modulate the assessment of severity.
¶ Patients who opt for active surveillance require close follow-up (eg, 2 to 4 weeks) to monitor for symptom progression.
Δ "Supplemental interventions" refer to interventions that can be added as adjuncts to active surveillance, antidepressants, psychotherapy, or combination treatment. These include exercise (recommended for all patients), internet-based psychotherapy, self-help interventions (support groups, smartphone applications), mind-body interventions (yoga, tai chi), and bright light therapy.
◊ At a given level of symptom severity, the following factors influence the selection of a treatment regimen: patient preferences, prior treatment experiences, history of prior episodes of depression, ability to engage in multiple treatments simultaneously (ie, when considering combination treatment or supplemental interventions), and availability and affordability of psychotherapy.
§ SSRIs, such as escitalopram or sertraline, are generally preferred medications for treating mild to moderate MDD. Refer to UpToDate topics on initial treatment with antidepressants for MDD in adults.
¥ To improve treatment feasibility and adherence, combination treatment can be administered sequentially (ie, start treatment 1, then start treatment 2 within 8 weeks). Refer to UpToDate topics on initial treatment with antidepressants for MDD in adults.
‡ We suggest SNRIs, such as venlafaxine or duloxetine, because some data suggest their superiority for treating severe MDD. SSRIs are reasonable alternatives. Refer to UpToDate topics on initial treatment with antidepressants for MDD in adults.آیا می خواهید مدیلیب را به صفحه اصلی خود اضافه کنید؟
