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VA/DoD Clinical Practice Guidelines

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Management of Major Depressive Disorder (MDD) (2009)


FDA Warning/Regulatory Alert
Note from the OQSV Evidence-Based Practice: This guideline references a drug(s) for which important revised regulatory and/or warning information has been released since completion of the CPG.

Recommendation Against Continued Use: March 28, 2012 – Citalopram Hydrobromide (CELEXA®): new changes have been made to the citalopram product label, specifically: ECG and/or electrolyte monitoring should be performed in patients prescribed citalopram who have relative contraindications to citalopram use, such as in those with comorbid conditions predisposing a risk of QT prolongation; Previous label recommendations that “contraindicated” citalopram use in patients with congenital QT syndrome because of the risk for QT prolongation have been changed to less stringent terminology of “not recommended” to recognize patients with this condition who could benefit from citalopram or who cannot tolerate other alternatives; The maximum dose of citalopram remains at 20mg/day for patients greater than the age of 60 years; Citalopram should be discontinued in patients with QTc measurements persistently above 500ms.
Link to Citalopram Notice

Image of Major Depressive Disorder GuidelineThe guideline describes the critical decision points in the management of Major Depressive Disorder (MDD) and provides clear and comprehensive evidence based recommendations incorporating current information and practices for practitioners throughout the DoD and VA Health Care systems. The guideline is intended to improve patient outcomes and local management of patients with MDD.

Disclaimer:This Clinical Practice Guideline is intended for use only as a tool to assist a clinician/healthcare professional and should not be used to replace clinical judgment.

About the CPG Guideline Links Patient-Provider Tools Related Guidelines
The guideline is formatted as three algorithms, with annotations:
  • Algorithm 1
    - Primary Care - Initial Assessment and Diagnosis
  • Algorithm 2
    - Primary Care - Initial Treatment
  • Algorithm 3
    - Primary Care - Treatment Management and Follow-Up
Questions about the MDD Guideline
MDD Full Text (2009)
PDF: Please Read; Urgent MDD Full Text (2009) Errata
MDD Summary (2009)
PDF: Please Read; Urgent MDD Summary (2009) Errata
MDD Pocket Card (2009)
PDF: Please Read; Urgent MDD Pocket Card (2009) Errata
VA/DoD Essentials for Depression Screening and Assessment in Primary Care
VA/DoD Clinical Practice Guideline Provider Reference Cards: Depression
DEPRESSION: Fast Facts Brochure
DEPRESSION: What You Need to Know
Substance Use Disorder (SUD)
Bipolar Disorder in Adults (BD)