School of Psychiatry, UNSW, Sydney, NSW, Australia.
Black Dog Institute, Sydney, NSW, Australia.
Acta Psychiatr Scand. 2018 Jun;137(6):459-471. doi: 10.1111/acps.12878. Epub 2018 Mar 25.
To determine the level of agreement across a set of evidence-based guidelines for management of the unipolar depressive disorders and with a focus on physical treatments.
A literature search was undertaken using the terms 'depression', 'depressive' and 'guidelines', using PubMed, Cochrane Database of Systematic Reviews and the National Guideline Clearinghouse. Twelve national psychiatric or professional guideline-producing organizations were identified from the period 2007-2017, with guidelines qualitatively reviewed by two assessors.
For major depressive disorder (MDD), there was general consensus to use an antidepressant (AD) in cases of greater severity, although disagreement on AD use in mild to moderate depression. There was some agreement on choice of AD class in first-line treatment recommendations, though great variability in second- and third-line management particularly in recommended augmentation and combined AD strategies. Electroconvulsive therapy was considered in all but one guideline, with other neurostimulation treatments being less consistently covered and with variable recommendations. Finally, there was low consistency in the management of dysthymia, persistent depressive disorder and treatment resistant depression.
Our review identifies varying levels of consistency in guideline recommendations. Strategies to improve reliability in guideline formulation should also improve their validity.
确定一套针对单相抑郁障碍管理的循证指南以及对物理治疗的重点的一致性水平。
使用“depression”、“depressive”和“guidelines”等术语，通过 PubMed、Cochrane 系统评价数据库和国家指南清除库进行文献检索。从 2007 年至 2017 年确定了 12 个国家精神病学或专业指南制定组织，由两名评估员对指南进行定性审查。
对于重度抑郁症（MDD），大多数指南都一致建议在病情更严重的情况下使用抗抑郁药（AD），但对于轻度至中度抑郁症的 AD 使用存在分歧。在一线治疗建议中，对于 AD 类别的选择存在一定程度的共识，但二线和三线管理的差异很大，尤其是在推荐的增效和联合 AD 策略方面。除了一个指南外，所有指南都考虑使用电惊厥疗法，而其他神经刺激治疗的覆盖范围则不那么一致，建议也各不相同。最后，心境恶劣障碍、持续性抑郁障碍和治疗抵抗性抑郁障碍的管理一致性程度较低。
我们的综述确定了指南建议中存在不同程度的一致性。改善指南制定可靠性的策略也应提高其有效性。
