Abstract
BackgroundRecommendations for pharmacological treatments of major depression with specific comorbid psychiatric conditions are lacking.MethodThe French Association for Biological Psychiatry and Neuropsychopharmacology and the fondation FondaMental developed expert consensus guidelines for the management of depression based on the RAND/UCLA Appropriatneness Method. Recommendations for lines of treatment are provided by the scientific committee after data analysis and interpretation of the results of a survey of 36 psychiatrist experts in the field of major depression and its treatments.ResultsThe expert guidelines combine scientific evidence and expert clinician’s opinion to produce recommendations for major depression with comorbid anxiety disorders, personality disorders or substance use disorders and in geriatric depression.ConclusionThese guidelines provide direction addressing common clinical dilemmas that arise in the pharmacologic treatment of major depression with comorbid psychiatric conditions.
Highlights
Recommendations for pharmacological treatments of major depression with specific comorbid psychiatric conditions are lacking
We provide a synthesis of the deliberations of a panel of experts highly specialized in the field of unipolar depression, thereby enabling to establish recommendations for the pharmacologic treatment of Major depressive disoder (MDD) in elderly patients, patients with comorbid anxiety disorders, personality disorders or substance use disorders
Within the limits of expert opinion and with the expectation that future research data will take precedence, these guidelines provide direction for addressing common clinical dilemmas that arise in the pharmacological treatment of MDD with comorbid conditions
Summary
Recommendations for pharmacological treatments of major depression with specific comorbid psychiatric conditions are lacking. A number of guidelines have already been developed by professional societies with the aim to standardize treatments and to orientate everyday clinical practice towards evidence base They integrate recommendations draws up after a critical analysis of available data, which are selected and ranked according to their level of evidence. The issue of comorbidity is recognized by EBGs, few specific recommendations are provided regarding acute treatment with antidepressant drugs, practical issues in prescribing and management or next-step treatment in those complex clinical situations. In these cases, the Formal Consensus method, based on the practical experience of a panel of experts, offer support strategies and appears to be relevant. This method has been previously used by the French Association for Biological Psychiatry and Neuropsychopharmacology (AFPBN) and the fondation FondaMental (www.fondation-fondamental.org) to make recommendations for pharmacological and psychological strategies in depression (Bennabi et al, submitted)
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