Figure 1 Management algorithm for patients with major depression Major depressive episode (based on DSM IV rating) ECT ± anti- Requiring rapid treatment depressants ± due to psychosis or suicide psychological Yes risk? therapies No Non-physical therapy† 1st and 2nd-line Psychological Anti-depressants ± therapies therapies psychological therapies No response/ Response partial response Considered to have anti-depressant treatment resistant depression rTMS ± anti- ECT ± anti- Anti-depressants (3rd or subsequent line, depressants ± depressants ± 3rd and augmented with other agents, or combination psychological psychological subsequent - antidepressants) ± psychological therapies therapies therapies line therapies No response/ Response Relapse partial response Remission Relapse Recovery Recurrence Maintenance * = Different course of treatment. Patients considered to No further treatment have treatment resistant depression are required to have at treatment least two courses of failed antidepressant therapy Physical therapies = ECT and rTMS †
Figure 1 Management algorithm for patients with major depression Major depressive episode (based on DSM IV rating) Requiring rapid treatment due to psychosis or suicide risk? Yes ECT ± anti- depressants ± psychological therapies No Non-physical therapy† Anti-depressants ± psychological therapies Psychological therapies 1st and 2nd-line therapies Response No response/ partial response Considered to have anti-depressant treatment resistant depression Anti-depressants (3rd or subsequent line, augmented with other agents, or combination antidepressants) ± psychological therapies rTMS ± anti- depressants ± psychological therapies ECT ± anti- depressants ± psychological therapies 3rd and subsequent - line therapies No response/ partial response Response Relapse Remission Relapse Recovery Recurrence * = Different course of treatment. Patients considered to have treatment resistant depression are required to have at least two courses of failed antidepressant therapy † Physical therapies = ECT and rTMS No further treatment Maintenance treatment
App1196-rTMS-FinalDAP-accessible.docx