Getting depression clinical practice guidelines right: time for change?

Area of Science:

• Psychiatry
• Chronobiology
• Mood Disorders

Background:

• Chronobiology plays a role in mood disorders.
• Recent clinical practice guidelines (CPGs) for depression treatment were reviewed.
• The review focused on recommendations for chronobiological treatments.

Purpose of the Study:

• To evaluate current western CPGs for depression treatment.
• To assess the integration of chronobiological treatments within these guidelines.
• To consider the methodological implications of guideline development.

Main Methods:

• A review of five international treatment guidelines published within the last five years.
• Guidelines represented North American and European perspectives.
• Recommendations were synthesized and discussed.

Main Results:

• Most CPGs provide limited detail on chronobiology.
• Chronotherapeutic recommendations are tentative.
• Agomelatine is noted for major depression; bright light therapy for SAD; sleep deprivation is not routinely recommended.

Conclusions:

• Lack of reliable therapeutic markers hinders chronotherapeutic recommendations.
• Evidence supports light therapy for seasonal depression.
• Insufficient evidence exists to prioritize chronotherapeutics over established treatments for non-seasonal depression.