Major depressive disorder
Also known as: depression · MDD
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Clinical Practice Guideline for the Treatment of Depression Across Three Age Cohorts
American Psychological Association (APA) · 2019
A US national guideline covering treatment of depression in children/adolescents, adults, and older adults. It sets out recommendations derived from systematic evidence review with attention to benefits, harms, patient preferences, and applicability across populations. A panel was appointed in 2025 to develop an update, so users should check the landing page for a newer edition before citing.
- Organised around three separate age cohorts rather than a single adult population. source
- Recommendations are based on systematic evidence review plus weighing of benefits, harms and patient values. source
- An update process was initiated in 2025; the 2019 document remains the posted current version. source
Depression in adults: treatment and management
NICE (UK) · 2022 · NG222
UK national guidance on identifying, treating and managing depression in people aged 18 and over. It covers first-episode care, further-line options, relapse prevention, and specific situations such as chronic depression, psychotic depression, and depression alongside a personality disorder diagnosis. A 2026 surveillance review concluded the recommendations remain current.
US vs EU key differences
- First-line antidepressant positioning differs: the American Psychological Association guideline presents psychotherapy and second-generation antidepressants as equally acceptable initial options chosen by shared decision-making, while NICE tells clinicians not to routinely offer antidepressants as first-line treatment for less severe depression unless the person prefers them. source
- Severity framing differs: NICE splits depression into 'less severe' (PHQ-9 under 16) and 'more severe' (PHQ-9 16 or above) and matches treatment menus to that split, whereas the US guideline is organised by age cohort (children/adolescents, adults, older adults) rather than by a symptom-score threshold. source
- NICE publishes an explicitly ranked menu of first-line options for less severe depression, led by guided self-help and group CBT or behavioural activation with SSRIs far down the list; the US guideline names seven psychotherapies plus SSRIs/SNRIs/NDRIs without ranking any option above another. source
- Issuing body and currency differ: the US entry is the American Psychological Association's 2019 guideline covering three age cohorts, while the European reference is NICE NG222, refreshed in 2022 and including detailed stepwise antidepressant tapering advice (roughly 25% dose reductions, slower for short half-life drugs). source
What changed recently
- EUCG90 (2009) → NG2222022-06-29
NG222 updates and replaces CG90, abandoning the 2009 stepped-care model in favour of a two-category split into less severe and more severe depression, with a menu of treatment options that patients choose from through shared decision-making rather than a fixed intensity ladder. It also newly covers further-line treatment, chronic depression, depression with coexisting personality disorder and psychotic depression, and adds guidance on reviewing and stopping antidepressants.
source ↗curation confidence 90%
See the full update feed for changes across every system.