U.S. Veterans Affairs/Department of Defense guidelines on the treatment of major depressive disorder

Clinical Question

How should major depressive disorder be treated, according to the U.S. Department of Veterans Affairs and Department of Defense guidelines?

Bottom line

New recommendations in these guidelines include monitoring patients with depression via an ongoing measurement tool and reserving ketamine/esketamine for patients who have not responded to several adequate trials of drug therapy. The recommendations do not prioritize either psychotherapy or drug therapy but suggest choosing a single approach for uncomplicated depression. You can find the full guidelines on the U.S. Department of Veterans Affairs website. 5

Study design: Practice guideline

Funding: Government

Setting: Various (guideline)


Allen F. Shaughnessy, PharmD, MMedEd
Professor of Family Medicine
Tufts University
Boston, MA

Discuss this POEM



Depression Therapy in the VA

Fascinated that Ketamine therapy is included!


trd mdd breakthrough



guidelines for depression

re assuring


Guidelines dissatisfaction

Useful in primary care only as they exclude key drugs like TCAs and MAOi before ketamine. The evidence us to the contrary. These older drugs have far lower NNT than most new ones including ketamine and Spravato ($$$$) which is still pretty experimental and has no end point and is expensive. I know the guidelines were suppose to be bias free, but…I need to look closer…


Impact assessment

Very good