Review of the guidelines of the Brazilian Medical Association for the treatment of depression (Full version) Revisão das diretrizes da Associação Médica Brasileira para o tratamento da depressão (Versão integral)

1 Department of Psychiatry and Legal Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre (RS), Brazil 2 Mood Disorders Program (PROTHUM), Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre (RS), Brazil 3 Department of Psychiatry, McGill University, Montreal, Quebec, Canada 4 Douglas Mental Health University Institute, Montreal, Quebec, Canada 5 Department of Psychiatry, Medical School, Universidade de São Paulo (USP), São Paulo (SP), Brazil 6 Bipolar Disorder Program (PROMAN), Institute of Psychiatry, Clinical Hospital, Medical School, Universidade de São Paulo (HC-FMUSP), São Paulo (SP), Brazil 7 Department of Neuropsychiatry, Universidade Federal de Pernambuco (UFPE), Recife (PE), Brazil 8 Assistance, Teaching and Research Nucleus on Affective Disorders, Clinical Hospital, Universidade Federal de Pernambuco (UFPE), Recife (PE), Brazil 9 Paulista Medical School (EPM), Universidade Federal de São Paulo (Unifesp), São Paulo (SP), Brazil 10 Medical School, Universidade Federal do Rio de Janeiro (UFRJ) Rio de Janeiro (RJ), Brazil 11 Former President of the Brazilian Psychiatry Association 12 Department of Neurosciences and Behavioral Sciences, Psychiatric Division, Faculdade de Medicina de Ribeirão Preto (FMRP), Universidade de São Paulo (USP), Ribeirão Preto (SP), Brazil 13 Section of Neurobiology of Mood Disorders, Institute of Psychiatry, King’s College London, London, UK 14 Faculdade de Medicina de Ribeirão Preto (FMRP), Universidade de São Paulo (USP), Ribeirão Preto (SP), Brazil Abstract Objective: Depression is a frequent, recurrent and chronic condition with high levels of functional disability. The Brazilian Medical Association Guidelines project proposed guidelines for diagnosis and treatment of the most common medical disorders. The objective of this paper is to present a review of the Guidelines Published in 2003 incorporating new evidence and recommendations. Method: This review was based on guidelines developed in other countries and systematic reviews, randomized clinical trials and when absent, observational studies and recommendations from experts. The Brazilian Medical Association proposed this methodology for the whole project. The review was developed from new international guidelines published since 2003. Results: The following aspects are presented: prevalence, demographics, disability, diagnostics and sub-diagnosis, efficacy of pharmacological and psychotherapeutic treatment, costs and side-effects of different classes of available drugs in Brazil. Strategies for different phases of treatment are also discussed. Conclusion: The Guidelines are an important tool for clinical decisions and a reference for orientation based on the available evidence in the literature.