World Federation of Societies of Biological Psychiatry (WFSBP) Guidelines for Biological Treatment of Unipolar Depressive Disorders, Part 1: Update 2013 on the acute and continuation treatment of unipolar depressive disorders

Abstract

Objectives. This 2013 update of the practice guidelines for the biological treatment of unipolar depressive disorders was developed by an international Task Force of the World Federation of Societies of Biological Psychiatry (WFSBP). The goal has been to systematically review all available evidence pertaining to the treatment of unipolar depressive disorders, and to produce a series of practice recommendations that are clinically and scientifically meaningful based on the available evidence. The guidelines are intended for use by all physicians seeing and treating patients with these conditions. Methods. The 2013 update was conducted by a systematic update literature search and appraisal. All recommendations were approved by the Guidelines Task Force. Results. This first part of the guidelines (Part 1) covers disease definition, classification, epidemiology, and course of unipolar depressive disorders, as well as the management of the acute and continuation phase treatment. It is primarily concerned with the biological treatment (including antidepressants, other psychopharmacological medications, electroconvulsive therapy, light therapy, adjunctive and novel therapeutic strategies) of adults. Conclusions. To date, there is a variety of evidence-based antidepressant treatment options available. Nevertheless there is still a substantial proportion of patients not achieving full remission. In addition, somatic and psychiatric comorbidities and other special circumstances need to be more thoroughly investigated. Therefore, further high-quality informative randomized controlled trials are urgently needed.

Key words::

• Major depressive disorder
• acute treatment
• continuation treatment
• pharmacotherapy
• antidepressants

Acknowledgements

We would like to thank Marie Jüngst (Berlin) for help with the literature search and Pamela Cohen (Berlin) for editorial assistance with English language.

Statement of Interest

The preparation of these WFSBP guidelines has not been financially supported by any commercial organization.

M. Bauer has received Grant/Research Support from Deutsche Forschungsgemeinschaft, European Commission (FP7), American Foundation for Suicide Prevention, Bundesministerium für Bildung und Forschung (BMBF). He is a consultant for Alkermes, AstraZeneca, BristolMyers Squibb, Ferrer Internacional, Janssen, Lilly, Lundbeck, Otsuka, Servier, Takeda. He has received speaker honoraria from AstraZeneca, BristolMyers Squibb, GlaxoSmithKline, Lilly, Lundbeck, Otsuka. Pfizer.

H.-J. Möller has received grants or is a consultant for and on the speakership bureaus of AstraZeneca, Bristol-Myers Squibb, Eisai, Eli Lilly, GlaxoSmithKline, Janssen Cilag, Lundbeck, Merck, Novartis, Organon, Pfizer, Sanofi-Aventis, Schering-Plough, Schwabe, Sepracor, Servier and Wyeth.

A. Pfennig received a stipend/research support from GlaxoSmithKline and research support from AstraZeneca. She has received speaker honoraria from AstraZeneca and Eli Lilly and Company.

E. Severus received Grant/Research Support from EPAX. He is a consultant for AstraZeneca, Bristol-Myers Squibb and Lundbeck.

Notes

¹Note: It is emphasized that a graded efficacy evaluation has its limitations. The strength of a recommendation reflects the scientific evidence on which it is based and not necessarily its importance.

²Note: Abbreviations used for antidepressant groups vary in the literature. For example, selective norepinephrine reuptake inhibitors are abbreviated as NRI or SNRI, selective serotonin and norepinephrine reuptake inhibitors as SNRI or SSNRI.

¹S3 Guideline DGPPN et al. (2009), *in monotherapy or in combination with psychotherapy, **in monotherapy or in combination with psychotherapy, ***and ECT or MAO-I, if appropriate.

¹See Bertilsson et al. (1997), Tanaka and Hisawa (1999), Steimer et al. (2001), Kirchheiner et al. (2004).

¹Bschor et al. (2003), ²Bauer et al. (2000), ³Bschor et al. (2002).

¹APA (2000).

¹Rush and Thase (1999).

¹Thase (1999), Rush and Kupfer (2001). ²Rosenbaum et al. (1998), ³APA (2000).

¹Fawcett and Barkin (1998), Rudolph et al. (1998), Schneier et al. (2003), Brady and Clary (2003).

¹APA (2009), Ninan et al. (2002).

¹Scott et al. (1998).

¹Coupland et al. (2011), ²Anderson et al. (2000).