title: Getting depression clinical practice guidelines right: time for change?
abstract: OBJECTIVE
  As part of a series of papers ['Chronobiology of mood disorders' Malhi & Kuiper. Acta Psychiatr Scand 2013;128(Suppl. 444):2-15; and 'It's time we managed depression: The emerging role of chronobiology' Malhi et al. Acta Psychiatr Scand 2013;128(Suppl. 444):1] examining chronobiology in the context of depression, this article examines recent western clinical practice guidelines (CPGs) for the treatment of depression with respect to the recommendations they make, in particular as regards chronobiological treatments, and briefly considers the implications of their methodology and approach.
  
  
  METHODS
  Five international treatment guidelines, which had been published in the past 5 years, were identified, representing North American and European views. Chosen guidelines were reviewed by the authors, and the relevant recommendations were distributed for discussion and subsequent synthesis.
  
  
  RESULTS
  Most current guidelines do not address chronobiology in detail. Chronotherapeutic recommendations are tentative, although agomelatine is considered as an option for major depression and bright light therapy for seasonal affective disorder. Sleep deprivation is not routinely recommended.
  
  
  CONCLUSIONS
  Recommendations are limited by the lack of reliable therapeutic markers for chronotherapeutics. Current evidence supports use of light therapy in seasonal depression, but in non-seasonal depression there is insufficient evidence to support reliance on chronotherapeutics over existing treatment modalities.
authors.affiliation: CADE Clinic, Department of Psychiatry, Royal North Shore Hospital, Sydney, New South Wales, Australia.
authors.forename: S
authors.initials: S
authors.lastname: Kuiper
authors.forename: L
authors.initials: L
authors.lastname: McLean
authors.forename: K
authors.initials: K
authors.lastname: Fritz
authors.forename: L
authors.initials: L
authors.lastname: Lampe
authors.forename: G S
authors.initials: GS
authors.lastname: Malhi
mesh_terms: D003866:Depressive Disorder / Q000628:therapy*; D006801:Humans; D010507:Periodicity; D017410:Practice Guidelines as Topic
keywords: chronobiology; clinical practice guidelines; major depressive disorder; treatment