PRACTICE GUIDELINE FOR THE Treatment of Patients With ...

1 PRACTICE GUIDELINE FOR THE Treatment of Patients with major depressive DisorderThird EditionWORK GROUP ON major depressive DISORDERAlan J. Gelenberg, , ChairMarlene P. Freeman, C. Markowitz, F. Rosenbaum, E. Thase, H. Trivedi, S. Van Rhoads, , ConsultantINDEPENDENT REVIEW PANELV ictor I. Reus, , ChairJ. Raymond DePaulo, Jr., A. Fawcett, D. Schneck, A. Silbersweig, PRACTICE GUIDELINE was approved in May 2010 and published in October 2010. A GUIDELINE watch, summarizingsignificant developments in the scientific literature since publication of this GUIDELINE , may be available 2010, American Psychiatric Association.

2 APA makes this PRACTICE GUIDELINE freely available to promote its dissemination and use; however, copyright protections are enforced in full. No part of this GUIDELINE may be reproduced except as permitted under Sections 107 and 108 of Copyright Act. For permission for reuse, visit APPI Permissions & Licensing Center at DISCLOSURES/CONFLICTS OF INTERESTThe Work Group on major depressive Disorder reportsthe following potentially competing interests for the pe-riod from May 2005 to May 2010:Dr. Gelenberg reports consulting for Eli Lilly and Com-pany, Pfizer, Best PRACTICE , AstraZeneca, Wyeth, Cyber-onics, Novartis, Forest Pharmaceuticals, Inc.

3 , GlaxoSmith-Kline, ZARS Pharma, Jazz Pharmaceuticals, Lundbeck,Takeda Pharmaceuticals North America, Inc., eResearchTechnology, Dey Pharma, PGxHealth, and Myriad Genet-ics. He reports serving on speakers bureaus for Pfizer,GlaxoSmithKline, and Wyeth. He reports receiving re-search grant funding from Eli Lilly and Company, Pfizer,and GlaxoSmithKline. He reports stock ownership inHealthcare Technology Freeman reports that she received research supportfrom the Meadows Foundation, the National Institute forMental Health, the Food and Drug Administration,the Institute for Mental Health Research, Forest, Glaxo-SmithKline and Eli Lilly and Company (investigator-initiated trials), and Pronova Biocare (research materials).

4 She received an honorarium for case-based peer-reviewedmaterial for AstraZeneca s website. She reports consultingfor Ther-Rx, Reliant, and Pamlab. She reports receivingan honorarium for speaking at an APA continuing medicaleducation program that was sponsored by Forest and anhonorarium for speaking at a continuing medication edu-cation program sponsored by KV Pharmaceuticals. Shereports receiving an honorarium from Leerink Swann forparticipating in a focus Markowitz reports consulting for Ono Pharma-ceutical Co., Ltd. (2005). He reports receiving researchsupport from Forest Pharmaceuticals, Inc.

5 (2005). He re-ports receiving grant support from the National Instituteof Mental Health (2005 2013), the National Alliance forResearch in Schizophrenia and Depression (2005), andMINT: Mental Health Initiative (2005). He reports re-ceiving royalties from American Psychiatric Publishing, Inc.(2005 2010), Basic Books (2005 2010), Elsevier (2005 2010), and Oxford University Press (2007 2010).Dr. Rosenbaum reports attending advisory boards forBristol-Myers Squibb, Cephalon, Cyberonics, Forest Phar-maceuticals, Inc., Eli Lilly and Company, MedAvante,Neuronetics, Inc., Novartis, Orexigen Therapeutics, Inc.

6 ,Organon BioSciences, Pfizer, Roche Diagnostics, Sanofi-aventis, Shire, and Wyeth. He reports consulting for Aus-pex Pharmaceuticals, Compellis Pharmaceuticals, EPIXP harmaceuticals, Neuronetics, Inc., Organon BioSci-ences, Somaxon, and Supernus Pharmaceuticals, Inc. Hereports receiving honoraria from lectureships for Boeh-ringer Ingleheim, Bristol-Myers Squibb, Cyberonics,Forest Pharmaceuticals, Inc., Eli Lilly and Company, andSchwartz Pharma. He was involved in the creation ofthe Massachusetts General Hospital Psychiatry Academy(MGH-PA) and has served as a panelist in four satellitebroadcast programs.

7 MGH-PA programs that have indus-try support are always multi-sponsored, and curriculumdevelopment by the Academy is independent of sponsor-ship; the curricula from January 2005 to March 2009 in-cluded sponsorship support from AstraZeneca, Bristol-Myers Squibb, Cephalon, Eli Lilly and Company, ForestPharmaceuticals, Inc., GlaxoSmithKline, Janssen MedicalAffairs LLC, Ortho-McNeil Pharmaceutical, sanofi-aventis, Shire, and Wyeth. He reports equity holdings inCompellis Pharmaceuticals, MedAvante, and Thase reports that he provided scientific consulta-tion to AstraZeneca, Bristol-Myers Squibb, Eli Lilly &Company, Forest Pharmaceuticals, Inc.

8 , Gerson LehmanGroup, GlaxoSmithKline, Guidepoint Global, H. Lund-beck A/S, MedAvante, Inc., Neuronetics, Inc., Novartis,Otsuka, Ortho-McNeil Pharmaceuticals, PamLab, ,Pfizer (formerly Wyeth-Ayerst Laboratories), Schering-Plough (formerly Organon), Shire , Inc., SupernusPharmaceuticals, Takeda (Lundbeck), and Transcept Phar-maceuticals. He was a member of the speakers bureaus forAstraZeneca, Bristol-Myers Squibb, Eli Lilly and Com-pany, GlaxoSmithKline, Pfizer (formerly Wyeth-AyerstLaboratories), and Schering-Plough (formerly Organon).He received grant funding from Eli Lilly and Company,GlaxoSmithKline, the National Institute of Mental Health,the Agency for Healthcare Research and Quality, andSepracor, Inc.

9 He had equity holdings in MedAvante, Inc.,and received royalty income from American PsychiatricPublishing, Inc., Guilford Publications, Herald House,Oxford University Press, and Norton and wife was employed as the group scientific director forEmbryon (formerly Advogent), which does business withBristol-Myers Squibb and Trivedi reports that he was a consultant to or onspeaker bureaus for Abbott Laboratories, Inc., Abdi Ibra-him, Akzo (Organon Pharmaceuticals, Inc.), AstraZeneca,Bristol-Myers Squibb Company, Cephalon, Inc., Cyber-onics, Inc., Eli Lilly and Company, Evotec, Fabre KramerPharmaceuticals, Inc.

10 , Forest Pharmaceuticals, Glaxo-SmithKline, Janssen Pharmaceutica Products, , Johnson& Johnson , Meade-Johnson, Medtronic, Neuro-netics, Otsuka Pharmaceuticals, Parke-Davis Pharmaceuti-Copyright 2010, American Psychiatric Association. APA makes this PRACTICE GUIDELINE freely available to promote its dissemination and use; however, copyright protections are enforced in full. No part of this GUIDELINE may be reproduced except as permitted under Sections 107 and 108 of Copyright Act. For permission for reuse, visit APPI Permissions & Licensing Center at , Inc., Pfizer, Inc., Sepracor, Shire Development, SolvayPharmaceuticals, VantagePoint, and Wyeth-Ayerst Labo-ratories.