Since the publication in 2000 of the APA's Practice Guideline for the Treatment of Patients With Major Depressive Disorder, 2nd Edition (1), two important safety concerns have emerged (hepatotoxicity with nefazodone and suicide risk with antidepressants), and two new antidepressants have been approved for use (escitalopram and duloxetine). This watch describes these developments as well as evidence that has accrued since 2000 in other areas related to the treatment of major depressive disorder.

The American Psychiatric Association (APA) practice guidelines are developed by expert work groups using an explicit methodology that includes rigorous review of available evidence, broad peer review of iterative drafts, and formal approval by the APA Assembly and Board of Trustees. APA practice guidelines are intended to assist psychiatrists in clinical decision making. They are not intended to be a standard of care. The ultimate judgment regarding a particular clinical procedure or treatment plan must be made by the psychiatrist in light of the clinical data presented by the patient and the diagnostic and treatment options available. Guideline watches summarize significant developments in practice that have occurred since publication of an APA practice guideline. Watches may be authored and reviewed by experts associated with the original guideline development effort and are approved for publication by APA's Executive Committee on Practice Guidelines. Thus, watches represent the opinion of the authors and approval of the Executive Committee but not policy of the APA. This guideline watch was published in September 2005. Copyright © 2005 American Psychiatric Association. All rights reserved. Suggested citation: Fochtmann LJ, Gelenberg AJ: Guideline Watch: Practice Guideline for the Treatment of Patients With Major Depressive Disorder, 2nd Edition. Arlington, VA: American Psychiatric Association, 2005. Available online at http://www.psych.org/psych_pract/treatg/pg/prac_guide.cfm.