24 Jan 2023 • Published on the 23rd of January, 2023 The American College of Physicians (ACP) have issued an update of its guideline with clinical recommendations for nonpharmacologic and pharmacologic treatments of adults in the acute phase of major depressive disorder (MDD). In the updated clinical guideline, ACP recommends the use of either cognitive behavioural therapy (CBT) or second-generation antidepressants (SGAs) as initial treatment in adults with moderate to severe MDD, and suggests the combination of both, as an alternate initial treatment option.

ACP also suggests initiating CBT in adults with mild major depression. It stresses the importance of informed decision making when selecting treatment and taking patient preferences into account.

In summary, ACP recommends:

• Monotherapy with either CBT or an SGA as initial treatment in patients in the acute phase of moderate to severe MDD
• Combination therapy with CBT and an SGA as initial treatment in patients in the acute phase of moderate to severe MDD
• Monotherapy with CBT as initial treatment in patients in the acute phase of mild MDD
• One of the following options for patients in the acute phase of moderate to severe MDD who did not respond to initial treatment with an adequate dose of an SGA:
  • switching to or augmenting with CBT
  • switching to a different SGA or augmenting with a second pharmacological treatment

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