Box 1.

: Core guidelines adapted from AHCPR clinical practice guidelines¹³

• Antidepressant drugs are an effective treatment for major depressive disorder
• Antidepressants are the first line treatment for moderate to severe depression or psychotic or melancholic atypical symptoms (overeating, oversleeping, weight gain), at patient's request, if psychotherapy unavailable, or if previous response to drug. (Site must have identified at least one of the above qualifiers to be rated as in agreement with guideline)
• Psychotherapy can be an effective first line treatment for mild to moderate depression
• Initial treatment with a combination of drugs and psychotherapy is reasonable in only some circumstances (such as chronic prior course of illness or poor recovery between depressive episodes, psychotherapy alone or drugs alone only partly effective, history of psychosocial problems both during and outside depressive episodes, history of poor adherence to treatment)
• Electroconvulsive therapy may be effective in certain cases of severe depression