The Department of Veteran’s Affairs and the Department of Defense have released an official guideline for the management of major depressive disorder.
The VA/DoD recommends a collaborative care model that includes a structured approach including education, behavioral therapy, and the use of medicinal intervention (if needed). They strongly recommend starting with psychological component CBT to address behavioral issues, problem solving, and other things to give the patient actionable self-management advice and therapy.
Self-management techniques and healthy principles mentioned in their recommendations include:
- A balanced nutritious diet
- Exploring self-help texts
- Sleep hygiene and appropriate sleeping hours
- Tobacco abstinence
- Avoiding excessive caffeine
- Avoiding alcohol and other drugs
- Engaging in pleasurable activities
They also recommend certain medications as a first-line treatment:
- Selective serotonin reuptake inhibitor (except fluvoxamine) (SSRIs)
- Serotonin-norepinephrine reuptake inhibitor (SNRIs)
Which of the prior medications is best should be discussed with the treating physician. And, a combination of both self-management techniques and medication is recommended.
In cases where these treatments are not effective, the VA/DoD recommends alternative treatments, including rTMS therapy.