Ninewells Hospital & Medical School, Dundee, DD1 9SY

Treatment algorithms and guidelines

Advanced Interventions ServiceResourcesTreatment algorithms and guidelines

Treatment algorithms

In order to support and guide the treatment of depression and OCD we have developed evidence-based algorithms for treating these disorders. We have also written more detailed guidance on treating OCD which may be helpful for clinicians. You can download these documents (in PDF format) below.

Our treatment algorithms are framed within recognisable tiers of service (primary care, secondary care, specialist/ tertiary care) and all treatments are evidence-based. Although each tier is included, it is expected that most of the suggested steps might be most useful for psychiatrists in secondary care/ CMHTs.

Disclaimer

All prescribers need to be responsible for their own prescribing and there will always be factors that might make a specific treatment step unsuitable. Many patients may have already had trials of particular drugs, and so blind adherence to an algorithm is never sensible. We have intended the algorithms to be a framework for discussion and treatment planning between the clinician and the patient.

General principles

These treatment algorithms are informed by several principles:

  1. The algorithm needs to be simple, so all the underlying evidence is not included. Neither is lots of discussion about how to effect switchovers. We don't cover all side-effects for treatments since we expect clinicians to be able to inform patients appropriately and to prescribe safely.
  2. Where there is uncertainty about which treatment is preferred (a.k.a. equipoise), we believe that the patient should make this choice.
  3. Each step has a number of choices, most of which have similar risk/ benefit ratios.

Clinicians are, of course, not obliged to follow these steps before making a referral to the Advanced Interventions Service but the principles of how many treatments are likely to have been delivered within each tier of service delivery are often a factor when considering referrals and making treatment recommendations.

Other treatment guidelines

This is a list of current guidelines from UK-based organisations and other relevant bodies. They are written for clinicians but they should also be helpful for patients and carers to understand what treatments are available and/ or recommended for their condition.

Please be aware that guidelines do not always agree, and guidelines published at different times will often include/ exclude different treatments.

The ones from NICE are often the most relevant for UK-based patients since there is an expectation that NHS providers will deliver treatment that matches the NICE guidelines.

 

National Institute for Health and Care Excellence (NICE)

British Association of Psychopharmacology (BAP)

  • Cleare, A., Pariante, C. M., Young, A. H., et al (2015) Evidence-based guidelines for treating depressive disorders with antidepressants: A revision of the 2008 British Association for Psychopharmacology guidelines. Journal of Psychopharmacology, 29, 459-525. http://dx.doi.org/10.1177/0269881115581093

Canadian Network for Mood and Anxiety Treatments (CANMAT)

  • Lam, R. W., McIntosh, D., Wang, J., et al (2016) Canadian Network for Mood and Anxiety Treatments (CANMAT) 2016 Clinical Guidelines for the Management of Adults with Major Depressive Disorder: Section 1. Disease Burden and Principles of Care. Canadian Journal of Psychiatry, 61, 510-523. http://dx.doi.org/10.1177/0706743716659416
  • Parikh, S. V., Quilty, L. C., Ravitz, P., et al (2016) Canadian Network for Mood and Anxiety Treatments (CANMAT) 2016 Clinical Guidelines for the Management of Adults with Major Depressive Disorder: Section 2. Psychological Treatments. Canadian Journal of Psychiatry, 61, 524-539. https://doi.org/10.1177/0706743716659418
  • Kennedy, S. H., Lam, R. W., McIntyre, R. S., et al (2016) Canadian Network for Mood and Anxiety Treatments (CANMAT) 2016 Clinical Guidelines for the Management of Adults with Major Depressive Disorder: Section 3. Pharmacological Treatments Canadian Journal of Psychiatry, 61, 540-560. https://doi.org/10.1177/0706743716659417
  • Milev, R. V., Giacobbe, P., Kennedy, S. H., et al (2016) Canadian Network for Mood and Anxiety Treatments (CANMAT) 2016 Clinical Guidelines for the Management of Adults with Major Depressive Disorder: Section 4. Neurostimulation Treatments. Canadian Journal of Psychiatry, 61, 561-575. https://doi.org/10.1177/0706743716660033

National Institute for Health and Care Excellence (NICE)

  • National Institute for Health and Clinical Excellence (2006) CG31. Obsessive-compulsive disorder: core interventions in the treatment of obsessive-compulsive disorder and body dysmorphic disorder. London: National Collaborating Centre for Mental Health. http://www.nice.org.uk/CG031
  • National Institute for Health and Care Excellence (2013) Obsessive-compulsive disorder: Evidence Update September 2013. London: National Collaborating Centre for Mental Health. http://arms.evidence.nhs.uk/resources/hub/1028833/attachment

British Association of Psychopharmacology (BAP)

  • Baldwin, D. S., Anderson, I. M., Nutt, D. J., et al (2014) Evidence-based pharmacological treatment of anxiety disorders, post-traumatic stress disorder and obsessive-compulsive disorder: A revision of the 2005 guidelines from the British Association for Psychopharmacology. Journal of Psychopharmacology, 28, 403-439. http://doi.org/10.1177/0269881114525674

American Psychiatric Association (APA)

Other

  • Janardhan Reddy, Y., Sundar, A., Narayanaswamy, J., et al (2017) Clinical practice guidelines for Obsessive-Compulsive Disorder. Indian Journal of Psychiatry, 59, 74-90. http://doi.org/10.4103/0019-5545.196976
  • Katzman, M. A., Bleau, P., Blier, P., et al (2014) Canadian clinical practice guidelines for the management of anxiety, posttraumatic stress and obsessive-compulsive disorders. BMC Psychiatry, 14, S1. http://doi.org/10.1186/1471-244X-14-S1-S1

National Institute for Health and Care Excellence (NICE)

  • NICE (2014) CG185. The assessment and management of bipolar disorder in adults, children and young people in primary and secondary care. London: National Collaborating Centre for Mental Health. http://www.nice.org.uk/Guidance/CG185

British Association of Psychopharmacology (BAP)

  • Goodwin, G., Haddad, P., Ferrier, I., et al (2016) Evidence-based guidelines for treating bipolar disorder: Revised third edition recommendations from the British Association for Psychopharmacology. Journal of Psychopharmacology, 30, 495-553. http://doi.org/10.1177/0269881116636545

Canadian Network for Mood and Anxiety Treatments (CANMAT)

  • Yatham, L. N., Kennedy, S. H., Parikh, S. V., et al (2013) Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) collaborative update of CANMAT guidelines for the management of patients with bipolar disorder: update 2013. Bipolar Disorders, 15, 1-44. http://doi.org/10.1111/bdi.12025

European Society for the Study of Tourette Syndrome (ESSTS)

  • Szejko, N., Robinson, S., Hartmann, A., et al (2022) European clinical guidelines for Tourette syndrome and other tic disorders - version 2.0. Part I: assessment. European Child & Adolescent Psychiatry, 31, 383-402. https://doi.org/10.1007/s00787-021-01842-2
  • Andrén, P., Jakubovski, E., Murphy, T. L., et al (2022) European clinical guidelines for Tourette syndrome and other tic disorders - version 2.0. Part II: psychological interventions. European Child & Adolescent Psychiatry, 31, 403-423. https://doi.org/10.1007/s00787-021-01845-z
  • Roessner, V., Eichele, H., Stern, J. S., et al (2022) European clinical guidelines for Tourette syndrome and other tic disorders - version 2.0. Part III: pharmacological treatment. European Child & Adolescent Psychiatry, 31, 425-441. https://doi.org/10.1007/s00787-021-01899-z
  • Szejko, N., Worbe, Y., Hartmann, A., et al (2022) European clinical guidelines for Tourette syndrome and other tic disorders -version 2.0. Part IV: deep brain stimulation. European Child & Adolescent Psychiatry, 31, 443-461. https://doi.org/10.1007/s00787-021-01881-9
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