Epworth Centre for Innovation in Mental Health, Epworth Healthcare, Camberwell, VIC, Australia.
Department of Psychiatry, Monash University, Melbourne, VIC, Australia.
Aust N Z J Psychiatry. 2021 Apr;55(4):349-354. doi: 10.1177/00048674211004344.
Clinical practice guidelines are important documents as they have the capacity to significantly influence and shape clinical practice in important areas of therapeutics. As such, they need to be developed informed by comprehensive and quality-based systematic reviews, involve consensus deliberations representative of the appropriate experts in the field and be subject to thorough critical review. A revised clinical practice guideline for the management of patients with mood disorders was recently published under the auspices of the Royal Australian and New Zealand College of Psychiatrists. However, this clinical practice guideline was not developed in a manner that reflects the appropriate standards that should apply to clinical practice guideline development and it has critical flaws, especially as it pertains to the use of repetitive transcranial magnetic stimulation treatment for patients with depression. The revision of the college clinical practice guideline has explicitly removed clear and unequivocal evidence-based recommendations that were found in a previous version of the clinical practice guideline and replaced these with consensus-based recommendations. However, the consensus-based recommendations were developed without consultation of the appropriate expert body within the college and contradict the scientific literature. There is substantive and unequivocal evidence supporting the antidepressant use of repetitive transcranial magnetic stimulation in the treatment of patients with depression and its use after a patient with depression has failed a limited number (typically around two) of antidepressant medication trials. Readers should refer to the college Professional Practice Guidelines for repetitive transcranial magnetic stimulation published in 2018 for thorough information about the use of this important new treatment.
临床实践指南是非常重要的文件，因为它们有能力在治疗的重要领域显著影响和塑造临床实践。因此，它们需要基于全面和基于质量的系统评价来制定，涉及该领域适当专家的共识审议，并经过严格的批判性审查。最近，在澳大利亚和新西兰皇家精神科医学院的主持下发布了一份治疗心境障碍患者的临床实践指南修订版。然而，该临床实践指南的制定方式并没有反映出应适用于临床实践指南制定的适当标准，而且存在严重缺陷，特别是在重复经颅磁刺激治疗抑郁症患者方面。该学院临床实践指南的修订明确删除了之前版本临床实践指南中发现的明确和明确的基于证据的建议，并以共识为基础的建议取代了这些建议。然而，共识为基础的建议是在没有咨询学院内适当专家机构的情况下制定的，并且与科学文献相矛盾。有大量确凿的证据支持重复经颅磁刺激在治疗抑郁症患者中的抗抑郁作用，以及在患者经历了有限数量（通常约为两个）的抗抑郁药物试验失败后使用这种治疗方法。读者应参考 2018 年发布的学院专业实践指南，以获取有关这种重要新治疗方法使用的详细信息。
