The AHRQ Clinical Guidelines are no longer available due to funding. Please go to the website for the National Centers for Complementary and Integrative Health https://nccih.nih.gov/health/providers/clinicalpractice.htm and review a guideline of a disease commonly seen in your practice (current or future) area. OR use a similar evidence-based website related to your current or future area. Provide an overview of the recommendations in this guideline. Does your practice follow this guideline? Why or why not?

The AHRQ Clinical Guidelines are no longer available due to funding. Please go to the website for the National Centers for Complementary and Integrative Health https://nccih.nih.gov/health/providers/clinicalpractice.htm and review a guideline of a disease commonly seen in your practice (current or future) area. OR use a similar evidence-based website related to your current or future area. Provide an overview of the recommendations in this guideline. Does your practice follow this guideline? Why or why not?

The AHRQ Clinical Guidelines are no longer available due to funding. Please go to the following website at the National Centers for Complementary and Integrative Health and review a guideline of a disease commonly seen in your practice area. : Major depression and anxiety. Provide an overview of the recommendations in this guideline. Include in your discussion how your practice follows this guideline.              https://nccih.nih.gov/health/providers/clinicalpractice.htm

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Nonpharmacologic Versus Pharmacologic Treatment of Adult Patients With Major Depressive Disorder: A Clinical Practice Guideline From the American College of Physicians. 

The American College of Physicians (ACP) created this guideline to provide the evidence and make therapeutic recommendations for treating the major depressive disorder in adults with second-generation antidepressants versus nonpharmacologic therapies (Qaseem, Barry & Kansagara, 2016).

This guideline is based on a systematic evaluation of published, English-language, randomized, controlled trials from 1990 to September 2015, which was conducted utilizing numerous databases and manual searches of pertinent study references. Interventions evaluated include psychotherapies, complementary and alternative medicines (including acupuncture, ω-3 fatty acids, S-adenosyl-L-methionine, St. John's wort [Hypericum perforatum]), exercise, and second-generation antidepressants. Evaluated outcomes included response, remission, functional capacity, quality of life, reduction of suicidality or hospitalizations, and harms. The intended audience for this guideline is all physicians, with adults with major depressive illness as the primary patient population. The evidence and recommendations in this guideline are graded using the ACP's clinical practice guidelines grading methodology (Qaseem, Barry & Kansagara, 2016).

Recommendation:

After examining treatment outcomes, adverse effect profiles, cost, accessibility, and preferences with the patient, the ACP recommends that practitioners choose between cognitive behavioral therapy or second-generation antidepressants to treat patients with severe depressive disorder (Grade: strong recommendation, moderate-quality evidence) (Qaseem, Barry & Kansagara, 2016).

In healthcare settings, cognitive behavioral therapy (CBT) is currently one of the most evidence-based psychological interventions for the treatment of several psychiatric disorders such as depression, anxiety disorders, somatoform disorder, and substance use disorder. There is no absolute contraindication to CBT; however, it is often reported that clients with comorbid severe personality disorders such as antisocial personality disorders and subnormal intelligence are difficult to manage through CBT. Special training and expertise may be needed for the treatment of these clients (Gautam, Tripathi, Deshmukh, & Gaur, 2020).

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REFERENCES:

https://www.nccih.nih.gov/health/providers/clinicalpractice

Qaseem A., Barry, M., & Kansagara, D. (2016). Nonpharmacologic versus pharmacologic treatment of adult patients with major depressive disorder: a clinical practice guideline from the American College of Physicians. ACP Journals. 

Gautam, M., Tripathi, A., Deshmukh, D., & Gaur, M. (2020). Cognitive Behavioral Therapy for Depression. Indian journal of psychiatry, 62(Suppl 2), S223-S229. https://doi.org/10.4103/psychiatry.IndianJPsychiatry_772_19