Major depressive disorder treatment guidelines in Japan

Japanese treatment guidelines, consensus guidelines, and treatment algorithms for managing patients with major depressive disorder (MDD) have been developed and/or updated in the past decade. The treatment guidelines, which are evidence-based, are the most detailed of the 3 types of guidance; they describe how to establish a treatment plan, treatment methods, and special problems such as intractable depression and suicide. The Japanese consensus guidelines were compiled from the results of a survey about treatment choices in MDD that was sent to members of the Japanese Society of Psychiatry and Neurology. Selective serotonin reuptake inhibitors and serotonin-norepinephrine reuptake inhibitors were the most common first-line treatments, followed by tricyclic antidepressants and tetracyclic antidepressants. The consensus guidelines are not evidence-based but are practical and easy to use. The Japanese treatment algorithm for MDD is a flowchart created in conjunction with the International Psychopharmacology Algorithm Project. The flowchart shows steps in treatment both for patients who respond to initial treatment and for those who need several trials of treatment. These 3 forms of guidance for managing patients with MDD in Japan are reviewed.