Quality of clinical practice guidelines for inadequate response to first-line treatment for depression according to AGREE II checklist and comparison of recommendations: a systematic review

• Published in: BMJ open 2022-04, Vol.12 (4), p.e051918-e051918
• Main Authors: Gabriel, Franciele Cordeiro, Stein, Airton Tetelbom, de Melo, Daniela Oliveira, Henrique Fontes-Mota, Géssica Caroline, dos Santos, Itamires Benício, de Oliveira, Aliandra Fantinell, Fráguas, Renério, Ribeiro, Eliane
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Antidepressive Agents - therapeutic use; Checklist; Clinical medicine; clinical pharmacology; Clinical practice guidelines; Coronaviruses; COVID-19; depression & mood disorders; Depression - diagnosis; Depression - drug therapy; Humans; Medical personnel; Medical research; Mental depression; Mental disorders; Mental Health; Mental health care; Pandemics; Patients; psychiatry; Systematic review
• ISSN: 2044-6055; 2044-6055
• DOI: 10.1136/bmjopen-2021-051918

ObjectiveTo assess similarities and differences in the recommended sequence of strategies among the most relevant clinical practice guidelines (CPGs) for the treatment of depression in adults with inadequate response to first-line treatment.Data sourcesWe performed a systematic review of the literature spanning January 2011 to August 2020 in Medline, Embase, Cochrane Library and 12 databases recognised as CPGs repositories. CPGs quality was assessed using the Appraisal of Guidelines for Research and Evaluation II (AGREE II).Study selectionThe eligibility criteria were CPGs that described pharmacological recommendations for treating depression for individuals aged 18 years or older in outpatient care setting. We included CPGs considered of high-quality (≥80% in domain 3 of AGREE II) or recognised as clinically relevant.Data extractionTwo independent researchers extracted recommendations for patients who did not respond to first-line pharmacological treatment from the selected CPGs.ResultsWe included 46 CPGs and selected 8, of which 5 were considered high quality (≥80% in domain 3 of AGREE II) and 3 were recognised as clinically relevant. Three CPGs did not define inadequate response to treatment and 3 did not establish a clear sequence of strategies. The duration of treatment needed to determine that a patient had not responded was not explicit in 3 CPGs and was discordant in 5 CPGs. Most CPGs agree in reassessing the diagnosis, assessing the presence of comorbidities, adherence to treatment, and increase dosage as first steps. All CPGs recommend psychotherapy, switching antidepressants, and considering augmentation/combining antidepressants.ConclusionRelevant CPGs present shortcomings in recommendations for non-responders to first-line antidepressant treatment including absence and divergencies in definition of inadequate response and sequence of recommended strategies. Overall, most relevant CPGs recommend reassessing the diagnosis, evaluate comorbidities, adherence to treatment, increase dosage of antidepressants, and psychotherapy as first steps.PROSPERO registration numberCRD42016043364.