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VA/DoD Clinical Practice Guidelines


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Management of Major Depressive Disorder (MDD) (2009)

Update of CPG in Progress

FDA Warning/Regulatory Alert

FDA Warning/Regulatory Alert
This guideline references a drug(s) for which important revised regulatory and/or warning information has been released since completion of the CPG.

UPDATE-March 28, 2012

Post-marketing reports of QT interval prolongation and Torsades de Pointes associated with CELEXA® and its generic equivalents (citalopram) resulted in changes to the product labeling in August 2011. The Food and Drug Administration (FDA) announced further labeling changes on March 28,2012. Link to Citalopram Notice

UPDATE - September 15, 2015
CLOZAPINE: Drug Safety Communication - FDA Modifies Monitoring for Neutropenia; Approves New Shared REMS Program

FDA is making changes to the requirements for monitoring, prescribing, dispensing, and receiving the schizophrenia medicine clozapine, to address continuing safety concerns and current knowledge about a serious blood condition called severe neutropenia. Severe neutropenia is a dangerously low number of neutrophils, white blood cells that help fight infections. Severe neutropenia can be life-threatening. Link to Clozapine 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)