The 2020 Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for mood disorders
Abstract
Objectives: To provide advice and guidance regarding the management of mood disorders, derived from scientific evidence and supplemented by expert clinical consensus to formulate s that maximise clinical utility. Methods: Articles and information sourced from search engines including PubMed, EMBASE, MEDLINE, PsycINFO and Google Scholar were supplemented by literature known to the mood disorders committee (e.g. books, book chapters and government reports) and from published depression and bipolar disorder guidelines. Relevant information was appraised and discussed in detail by members of the mood disorders committee, with a view to formulating and developing consensus-based recommendations and clinical guidance. The guidelines were subjected to rigorous consultation and external review involving: expert and clinical advisors, key stakeholders, professional bodies and specialist groups with interest in mood disorders. Results: The Royal Australian and New Zealand College of Psychiatrists mood disorders clinical practice guidelines 2020 (MDcpg 2020 ) provide up-to-date guidance regarding the management of mood disorders that is informed by evidence and clinical experience. The guideline is intended for clinical use by psychiatrists, psychologists, primary care physicians and others with an interest in mental health care. Conclusion: The MDcpg 2020 builds on the previous 2015 guidelines and maintains its joint focus on both depressive and bipolar disorders. It provides up-to-date recommendations and guidance within an evidence-based framework, supplemented by expert clinical consensus. Mood disorders committee: Gin S Malhi (Chair), Erica Bell, Darryl Bassett, Philip Boyce, Richard Bryant, Philip Hazell, Malcolm Hopwood, Bill Lyndon, Roger Mulder, Richard Porter, Ajeet B Singh and Greg Murray.
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Two (10%) other CPGs stated that withdrawal symptoms and relapse should be differentiated from each other when discontinuing antidepressants, but without considering the potential overlap of symptoms between these situations.
“Two (10%) other CPGs stated that withdrawal symptoms and relapse should be differentiated from each other when discontinuing antidepressants, but without considering the potential overlap of symptoms between these situations.3,44”
From Clinical practice guideline recommendations on tapering and discontinuing antidepressants for depression: a systematic review (2022) · cites this paper as [3]
One (5%) of the CPGs suggested that patients in high risk of severe discontinuation symptoms reduce the dose first to the minimal effective dose, then halve that dose, and then reduce more slowly in small decrements, allowing 2 weeks for each dose reduction, according to how the tablet can be divided, and once minimum effective dose is achieved, reduce the dose by no more than 50% weekly.
“one (5%) of the CPGs suggested that patients in high risk of severe discontinuation symptoms reduce the dose first to the minimal effective dose, then halve that dose, and then ‘reduce more slowly in small decrements, allowing 2 weeks for each dose reduction, according to how the tablet can be divided. [...] once minimum effective dose is achieved, reduce the dose by no more than 50% weekly’. 3”
From Clinical practice guideline recommendations on tapering and discontinuing antidepressants for depression: a systematic review (2022) · cites this paper as [3]
Specific guidance for tapering tricyclic antidepressants was provided in one (5%) of the CPGs, recommending a slow taper over a longer period of time.
“and for tapering tricyclic antidepressants in one (5%) of the CPGs, recommending ‘a slow taper over a longer period of time’. 3”
From Clinical practice guideline recommendations on tapering and discontinuing antidepressants for depression: a systematic review (2022) · cites this paper as [3]
Only two (10%) of the CPGs explicitly recommended that patients should discontinue their antidepressant after maintenance treatment or continuation treatment.
“Only two (10%) of the CPGs, however, explicitly recommended that patients should discontinue their antidepressant after maintenance treatment 3 or continuation treatment; 28”
From Clinical practice guideline recommendations on tapering and discontinuing antidepressants for depression: a systematic review (2022) · cites this paper as [3]
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Serotonin Reuptake Inhibitor Withdrawal
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Patient Will See You Now: The Future of Medicine is in Your Hands
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A Cross-Sectional Study of Cannabidiol Users
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The Development of Coping: Implications for Psychopathology and Resilience
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Adjunctive Psychotherapy for Bipolar Disorder
Miklowitz, D. J., Efthimiou, O., Furukawa, T. A., Scott, J. L., McLaren, R., Geddes, J. R., & Cipriani, A. (2020) · JAMA Psychiatry · doi:10.1001/jamapsychiatry.2020.2993 · Cited by 286 · see citing works
A direct test of the diathesis-stress model for depression
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Tapering of SSRI treatment to mitigate withdrawal symptoms
Horowitz, M. A., & Taylor, D. (2019) · The Lancet Psychiatry · doi:10.1016/s2215-0366(19)30032-x · Cited by 280 · cited 2× · see citing works
“It has recently been suggested that antidepressants should be tapered down hyperbolically (by lowering the dose by smaller amounts over time) in the same manner as benzodiazepines (Horowitz and Taylor, 2019), which is further supported by a Dutch taskforce (Ruhe et al.”
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Self-citationTeratogenic effects of antiepileptic drugs
Tomson, T., & Battino, D. (2012) · The Lancet Neurology · doi:10.1016/s1474-4422(12)70103-5 · Cited by 277 · see citing works
Treatment of Complicated Grief in Elderly Persons: A Randomized Clinical Trial
Shear, M. K., Wang, Y., Skritskaya, N., Duan, N., Mauro, C., & Ghesquiere, A. (2014) · JAMA Psychiatry · doi:10.1001/jamapsychiatry.2014.1242 · Cited by 276 · see citing works
Attributional style and the generality of learned helplessness.
Alloy, L. B., Peterson, C., Abramson, L. Y., & Seligman, M. E. (1984) · Journal of Personality and Social Psychology · doi:10.1037//0022-3514.46.3.681 · Cited by 275 · see citing works
Flagged first, then by citations
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Singh, B., Olds, T., Curtis, R., Dumuid, D., Virgara, R., Watson, A., Szeto, K., O'Connor, E., Ferguson, T., Eglitis, E., et al. (2023) · British Journal of Sports Medicine · doi:10.1136/bjsports-2022-106195 · Cited by 1,049 · see citing works
“Four reviews 42 44 57 58 presented analyses by weekly session duration (68 component RCTs, >5016 participants, online supplemental eFigure 12).”
BackgroundMarx, W., Penninx, B. W. J. H., Solmi, M., Furukawa, T. A., Firth, J., Carvalho, A. F., & Berk, M. (2023) · Nature Reviews Disease Primers · doi:10.1038/s41572-023-00454-1 · Cited by 850 · see citing works
“170 .”
InfluentialNoetel, M., Sanders, T., Gallardo-Gómez, D., Taylor, P., del Pozo Cruz, B., van den Hoek, D., Smith, J. J., Mahoney, J., Spathis, J., Moresi, M., et al. (2024) · BMJ · doi:10.1136/bmj-2023-075847 · Cited by 707 · see citing works
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Virtual reality for supporting the treatment of depression and anxiety: scoping review
Baghaei, N., Chitale, V., Hlasnik, A., Stemmet, L., Liang, H.-N., & Porter, R. (2021) · JMIR Mental Health · doi:10.2196/29681 · Cited by 197 · see citing works
“It is supported by many guidelines as a first-line treatment for mood and anxiety disorders [6,7].”
BackgroundSelf-citationMarx, W., Manger, S., Blencowe, M., Murray, G., Ho, F. Y., Lawn, S., Blumenthal, J. A., Schuch, F. B., Stubbs, B., Ruusunen, A. A., et al. (2022) · The World Journal of Biological Psychiatry · doi:10.1080/15622975.2022.2112074 · Cited by 188 · see citing works
“The extent to which the lifestyle therapies of diet, exercise, sleep and substance cessation are foundational refers to care that ‘needs to be undertaken to facilitate functional recovery’ as per its definition in RANZCP guidelines (Malhi et al. 2021).”
BackgroundInfluentialSelf-citationMalhi, G. S., Bell, E., Boyce, P., Bassett, D., Berk, M., Bryant, R., Gitlin, M., Hamilton, A., Hazell, P., Hopwood, M., et al. (2020) · Bipolar Disorders · doi:10.1111/bdi.13036 · Cited by 152 · see citing works
“Therefore, to prevent both mania and depression, quetiapine can be combined with lithium (1) or valproate (2) and lithium can also be combined with aripiprazole (3) to prevent mania (*aripiprazole can also be administered as a long-acting depot) [Colour figure can be viewed at wileyonlinelibrary.”
BackgroundSelf-citationBipolar disorders: an update on critical aspects
Oliva, V., Fico, G., Prisco, M. D., Gonda, X., Rosa, A. R., & Vieta, E. (2024) · The Lancet Regional Health - Europe · doi:10.1016/j.lanepe.2024.101135 · Cited by 150 · see citing works
McCarthy, M. J., Gottlieb, J. F., Gonzalez, R., McClung, C. A., Alloy, L. B., Cain, S., Dulcis, D., Etain, B., Frey, B. N., Garbazza, C., et al. (2022) · Bipolar Disorders · doi:10.1111/bdi.13165 · Cited by 136 · see citing works
“(1) Circadian function as causal explanation for emergence of disorder (specificity important, cause important); (2) Circadian function as biomarker (specificity and sensitivity important, cause irrelevant); (3) Circadian function as endophenotype (quantitative and dimensional, specificity not important, causality imp…”
Self-citationMalhi, G. S., Bell, E., Singh, A., Bassett, D. L., Berk, M., Boyce, P. M., Bryant, R. A., Gitlin, M. J., Hamilton, A., Hazell, P., et al. (2020) · Bipolar Disorders · doi:10.1111/bdi.13035 · Cited by 120 · see citing works
“The first antidepressant (1) is then prescribed at the optimal dose and this can be increased (Increase Dose, ID) if necessary.”
BackgroundSelf-citationRosson, S., de Filippis, R., Croatto, G., Collantoni, E., Pallottino, S., Guinart, D., Brunoni, A. R., Dell’Osso, B. M., Pigato, G., Hyde, J., et al. (2022) · Neuroscience & Biobehavioral Reviews · doi:10.1016/j.neubiorev.2022.104743 · Cited by 112 · see citing works
Exercise as a therapeutic modality for the prevention and treatment of depression
Blumenthal, J. A., & Rozanski, A. (2023) · Progress in Cardiovascular Diseases · doi:10.1016/j.pcad.2023.02.008 · Cited by 95 · see citing works
Tayeb, A. E. K. A., Poinsignon, V., Chappell, K., Bouligand, J., Becquemont, L., & Verstuyft, C. (2023) · Antioxidants · doi:10.3390/antiox12040942 · Cited by 100 · see citing works
“Second, the underlying mechanisms of MDD are associated with various biological pathways intertwined with psychological and social factors [14].”
BackgroundDiagnosis and management of depression in adolescents
Korczak, D. J., Westwell-Roper, C. Y., & Sassi, R. B. (2023) · Canadian Medical Association Journal · doi:10.1503/cmaj.220966 · Cited by 86 · see citing works
Psychoeducation in bipolar disorder: A systematic review
Rabelo, J. L., Cruz, B. F., Ferreira, J. D. R., Viana, B. D. M., & Barbosa, I. G. (2021) · World Journal of Psychiatry · doi:10.5498/wjp.v11.i12.1407 · Cited by 76 · see citing works
Sørensen, A., Ruhé, H. G., & Munkholm, K. (2022) · Molecular Psychiatry · doi:10.1038/s41380-021-01285-w · Cited by 65 · see citing works
Clinical decision support for bipolar depression using large language models
Perlis, R. H., Goldberg, J. F., Ostacher, M. J., & Schneck, C. D. (2024) · Neuropsychopharmacology · doi:10.1038/s41386-024-01841-2 · Cited by 70 · see citing works
Understanding genetic risk factors for common side effects of antidepressant medications
Campos, A. I., Mulcahy, A., Thorp, J. G., Wray, N. R., Byrne, E. M., Lind, P. A., Medland, S. E., Martin, N. G., Hickie, I. B., & Rentería, M. E. (2021) · Communications Medicine · doi:10.1038/s43856-021-00046-8 · Cited by 60 · see citing works
Changes in antidepressant use in Australia: A nationwide analysis (2015–2021)
Costa, J. D. O., Gillies, M. B., Schaffer, A. L., Peiris, D., Zoëga, H., & Pearson, S. (2022) · Australian & New Zealand Journal of Psychiatry · doi:10.1177/00048674221079740 · Cited by 61 · see citing works
Treatment-Resistant Bipolar Depression: Therapeutic Trends, Challenges and Future Directions
Elsayed, O. H., Ercis, M., Pahwa, M., & Singh, B. (2022) · Neuropsychiatric Disease and Treatment · doi:10.2147/ndt.s273503 · Cited by 67 · see citing works
Nutrition and bipolar disorder: a systematic review
Gabriel, F. C., Oliveira, M., Martella, B. D. M., Berk, M., Brietzke, E., Jacka, F. N., & Lafer, B. (2023) · Nutritional Neuroscience · doi:10.1080/1028415x.2022.2077031 · Cited by 59 · see citing works
“and dysfunctional eating behaviors are modifiable risk factors, it is possible that thesewill be converted into critical interventions for mental health [3,9,10].”
BackgroundTikka, S. K., Siddiqui, M. A., Garg, S., Pattojoshi, A., & Gautam, M. (2023) · Indian Journal of Psychiatry · doi:10.4103/indianjpsychiatry.indianjpsychiatry_492_22 · Cited by 56 · see citing works
“…by an umbrella review of recent meta-analytic studies assessing the role of rTMS in various psychiatric disorders performed by the authors and supplemented by other clinical practice guidelines, [6] evidence-based guidelines, and umbrella reviews [7-9] , and consensus or expert recommendations.”
Singh, B., Bennett, H., Miatke, A., Dumuid, D., Curtis, R., Ferguson, T., Brinsley, J., Szeto, K., Eglitis, E., Zhou, M., et al. (2025) · Journal of the American Academy of Child & Adolescent Psychiatry · doi:10.1016/j.jaac.2025.04.007 · Cited by 62 · see citing works
Sørensen, A., Juhl Jørgensen, K., & Munkholm, K. (2022) · Therapeutic Advances in Psychopharmacology · doi:10.1177/20451253211067656 · Cited by 52 · see citing works
Bauer, M. S. (2022) · Annals of Internal Medicine · doi:10.7326/aitc202207190 · Cited by 51 · see citing works
The biopsychosocial model – history, controversy and Engel
Lugg, W. (2021) · Australasian Psychiatry · doi:10.1177/10398562211037333 · Cited by 50 · see citing works
The Psychiatric Symptomology of Visual Snow Syndrome
Solly, E. J., Clough, M., Foletta, P., White, O. B., & Fielding, J. (2021) · Frontiers in Neurology · doi:10.3389/fneur.2021.703006 · Cited by 50 · see citing works
“As with sleep dysfunction, a number of treatment avenues are available for anxiety and depression, both pharmacological and psychological (43, 44).”
BackgroundRatheesh, A., Hett, D., Ramain, J., Wong, E., Berk, L., Conus, P., Fristad, M. A., Goldstein, T. R., Hillegers, M. H. J., Jauhar, S., et al. (2023) · International Journal of Bipolar Disorders · doi:10.1186/s40345-022-00275-3 · Cited by 47 · see citing works
Self-citationStrauss, C., Bibby-Jones, A.-M., Jones, F., Byford, S., Heslin, M., Parry, G., Barkham, M., Lea, L., Crane, R., de Visser, R., et al. (2023) · JAMA Psychiatry · doi:10.1001/jamapsychiatry.2023.0222 · Cited by 45 · see citing works
“Mixed/multiple ethnic groups 9 (4) 11 (5)”
BackgroundCountering the declining use of lithium therapy: a call to arms
Malhi, G. S., Bell, E., Jadidi, M., Gitlin, M. J., & Bauer, M. (2023) · International Journal of Bipolar Disorders · doi:10.1186/s40345-023-00310-x · Cited by 44 · see citing works
Self-citationModulation of neuroimmune cytokine networks by antidepressants: implications in mood regulation
Nava, R. G., Adri, A. S., Filgueiras, I. S., Nóbile, A. L., Barcelos, P. M., Corrêa, Y. L. G., de Oliveira, S. F., Cabral‐Miranda, G., Dias, H. D., Schimke, L. F., et al. (2025) · Translational Psychiatry · doi:10.1038/s41398-025-03532-y · Cited by 51 · see citing works
“Lifestyle interventions (e.g., exercise, diet) could complement pharmacotherapy by reducing systemic in fl ammation and improving HRQL, as seen in general MDD populations [184, 185].”
Morales-Torres, R., Carrasco-Gubernatis, C., Grasso-Cladera, A., Cosmelli, D., Parada, F. J., & Palacios-García, I. (2023) · Nutrients · doi:10.3390/nu15071706 · Cited by 44 · see citing works
“From the clinical practice perspective, our results support the emphasis of recent psychiatry guidelines [93,94] and the nutritional and lifestyle psychiatry approach [64,86] to assess and prescribe lifestyle behaviors as a primary strategy, under both preventative and treatment approaches.”
ResultKetamine and other glutamate receptor modulators for depression in adults with bipolar disorder.
Dean, R. L., Marquardt, T., Hurducas, C. C., Spyridi, S., Barnes, A., Smith, R., Cowen, P., McShane, R., Hawton, K., Malhi, G., et al. (2021) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd011611.pub3 · Cited by 39 · see citing works
Self-citationVeraart, J. K. E., Smith-Apeldoorn, S. Y., Bakker, I. M., Visser, B. A. E., Kamphuis, J., Schoevers, R. A., & Touw, D. J. (2021) · The International Journal of Neuropsychopharmacology · doi:10.1093/ijnp/pyab039 · Cited by 46 · see citing works
“However, to date, there are no clinical practice guidelines recommending the use of S-ketamine in depression (López-Díaz et al., 2019; Malhi et al., 2021).”
BackgroundBrini, S., Brudasca, N. I., Hodkinson, A., Kaluzinska, K., Wach, A., Storman, D., Prokop-Dorner, A., Jemioło, P., & Bala, M. M. (2023) · Clinical Psychology Review · doi:10.1016/j.cpr.2022.102236 · Cited by 44 · see citing works
Management of depression in patients with coronary artery disease: A systematic review
Akóṣílè, W., Tiyatiye, B., Colquhoun, D., & Young, R. M. (2023) · Asian Journal of Psychiatry · doi:10.1016/j.ajp.2023.103534 · Cited by 41 · see citing works
Wong, D. K., Pike, K. E., Stolwyk, R. J., Allott, K., Ponsford, J. L., McKay, A., Longley, W. A., Bosboom, P. R., Hodge, M. A., Kinsella, G., et al. (2023) · Neuropsychology Review · doi:10.1007/s11065-023-09624-0 · Cited by 42 · see citing works
Amare, A. T., Thalamuthu, A., Schubert, K. O., Fullerton, J. M., Ahmed, M. B., Hartmann, S., Papiol, S., Heilbronner, U., Degenhardt, F., Ayele, F. T., et al. (2023) · Molecular Psychiatry · doi:10.1038/s41380-023-02149-1 · Cited by 39 · see citing works
“Since the discovery of lithium ’ s mood-stabilizing property in 1949 [5], it has been widely used as a fi rst-line therapy for patients with BD [6, 7].”
MethodCo‐occurring depression and insomnia in Australian primary care: recent scientific evidence
Sweetman, A., Lack, L. C., Ryswyk, E. V., Vakulin, A., Reed, R. L., Battersby, M., Lovato, N., & Adams, R. (2021) · The Medical Journal of Australia · doi:10.5694/mja2.51200 · Cited by 38 · see citing works
Bell, E., Boyce, P. M., Porter, R., Bryant, R. A., & Malhi, G. S. (2021) · CNS Drugs · doi:10.1007/s40263-021-00823-y · Cited by 37 · see citing works
“In mood disorders, and particularly bipolar disorder, mood stabilisers are frequently employed to ensure mood stability and reduce the likelihood of future episodes [106].”
BackgroundSelf-citationMcDonald, V. M., Hamada, Y., Agustí, A. G. N., & Gibson, P. G. (2024) · The Journal of Allergy and Clinical Immunology In Practice · doi:10.1016/j.jaip.2024.01.020 · Cited by 33 · see citing works
Bipolar II disorder: a state‐of‐the‐art review
Berk, M., Corrales, A., Trisno, R., Dodd, S., Yatham, L. N., Vieta, E., McIntyre, R. S., Suppes, T. M., & Agustini, B. (2025) · World Psychiatry · doi:10.1002/wps.21300 · Cited by 39 · see citing works
“Guidelines emphasize the importance of psychological interventions for the maintenance treatment of BD-II 244 .”
Halstead, S., Yap, C. X., Warren, N., Agarwal, S. M., Brand, B. A., Chan, S. K. W., Cipriani, A., Correll, C. U., Crossley, N. A., D’Ambrosio, E., et al. (2025) · The Lancet Psychiatry · doi:10.1016/s2215-0366(25)00162-2 · Cited by 34 · see citing works
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Lifestyle medicine for anxiety symptoms: A meta-analysis of randomized controlled trials
Wong, V. W.-H., Ho, F. Y., Shi, N.-K., Sarris, J. J., Ng, C. H., & Tam, O. K.-Y. (2022) · Journal of Affective Disorders · doi:10.1016/j.jad.2022.04.151 · Cited by 32 · see citing works
McIntyre, R. S., Florea, I., Pedersen, M. M., & Christensen, M. C. (2023) · The Journal of Clinical Psychiatry · doi:10.4088/jcp.23m14780 · Cited by 33 · see citing works
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Abnormal habenula functional connectivity characterizes treatment-resistant depression
Barreiros, A. R., Breukelaar, I. A., Mayur, P. M., Andepalli, J., Tomimatsu, Y., Funayama, K., Foster, S., Boyce, P. M., Malhi, G. S., Harris, A. W. F., et al. (2022) · NeuroImage Clinical · doi:10.1016/j.nicl.2022.102990 · Cited by 33 · see citing works
“This definition has also recently been reframed to include patients who fail to respond to neuromodulation and psychotherapies (Malhi et al., 2019).”
BackgroundSelf-citationOsou, S., Radjenovic, S., Bender, L., Gaal, M., Zettl, A., Dörl, G., Matt, E., & Beisteiner, R. (2023) · Journal of Neurology · doi:10.1007/s00415-023-12114-1 · Cited by 32 · see citing works
Tundo, A., Betrò, S., de Filippis, R., Marchetti, F., Nacca, D., Necci, R., & Iommi, M. (2023) · Life · doi:10.3390/life13041043 · Cited by 30 · see citing works
“ADs are employed in monotherapy for unipolar depression [3,9,10] and combined with mood stabilizers or second-generation antipsychotics for bipolar depression without mixed features, rapid-cycling course, and treatment-emergent manic/hypomanic switch [3,6,11,12].”
BackgroundXu, X., Xu, M., Su, Y., Cao, T. V., Nikolin, S., Moffa, A. H., Loo, C. K. A., & Martin, D. M. (2023) · Brain Sciences · doi:10.3390/brainsci13121665 · Cited by 31 · see citing works
Bourke, M., Patten, R. K., Dash, S. R., Pascoe, M. C., Craike, M. J., Firth, J., Bailey, A. P., Jacka, F. N., & Parker, A. G. (2021) · Journal of Adolescent Health · doi:10.1016/j.jadohealth.2021.08.005 · Cited by 31 · see citing works
Suppes, T. M., Durgam, S., Kozauer, S. G., Chen, R., Lakkis, H. D., Davis, R. E., Satlin, A., Vanover, K. E., Mates, S. L., McIntyre, R. S., et al. (2023) · Bipolar Disorders · doi:10.1111/bdi.13310 · Cited by 30 · see citing works
Chevance, A., Tomlinson, A., Ravaud, P., Touboul, S., Henshall, C. L., Tran, V.-T., & Cipriani, A. (2022) · Evidence-Based Mental Health · doi:10.1136/ebmental-2021-300418 · Cited by 29 · see citing works
Antidepressant discontinuation syndrome: A state-of-the-art clinical review
Fornaro, M., Cattaneo, C. I., Berardis, D. D., Ressico, F. V., Martinotti, G., & Vieta, E. (2022) · European Neuropsychopharmacology · doi:10.1016/j.euroneuro.2022.10.005 · Cited by 29 · see citing works
Hsu, C., Carvalho, A. F., Tsai, S., Wang, L., Tseng, P., Lin, P., Tu, Y., Vieta, E., Solmi, M., Hung, C., et al. (2021) · Acta Psychiatrica Scandinavica · doi:10.1111/acps.13346 · Cited by 28 · see citing works
“Due to the different ranges of lithium serum levels in the included studies, we used the following criteria to define the value of serum levels in the comparison group: (1) the mean or median of each serum level category; (2) when the ranges of each serum level category were reported, the average value of the lower an…”
BackgroundMethodRichardson, K. E., Petukhova, R., Hughes, S. D., Pitt, J., Yücel, M., & Segrave, R. A. (2024) · BMC Public Health · doi:10.1186/s12889-024-17683-y · Cited by 27 · see citing works
“Physical exercise, sleep, diet, mindfulness meditation, and strengthening positive relationships are examples of lifestyle medicine activities with demonstrated efficacy to prevent and treat a wide variety of mental illnesses; albeit to varying degrees [7, 9, 12, 13].”
BackgroundInfluentialEvaluating virtual reality technology in psychotherapy: impacts on anxiety, depression, and ADHD
Wang, P., Ai, X., Zhang, X. Q., Ma, F., Zhuang, Y., & Wang, S. (2024) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2024.1480788 · Cited by 28 · see citing works
Rice, L. J., Cannon, L., Dadlani, N., Cheung, M. M. Y., Einfeld, S., Efron, D., Dossetor, D. R., & Elliott, E. J. (2023) · European Child & Adolescent Psychiatry · doi:10.1007/s00787-023-02169-w · Cited by 27 · see citing works
“Clinical practice guidelines for the assessment and treat-ment of mood disorders note that the evidence for efficacy of CBD in depression remains unproven [62].”
BackgroundPrevalence of cognitive impairments and strengths in the early course of psychosis and depression
Stainton, A., Chisholm, K., Griffiths, S. L., Kambeitz‐Ilankovic, L., Wenzel, J., Bonivento, C., Brambilla, P., Iqbal, M., Lichtenstein, T., Rosen, M., et al. (2023) · Psychological Medicine · doi:10.1017/s0033291723001770 · Cited by 27 · see citing works
Francis, S. E. B., Shawyer, F., Cayoun, B. A., Grabovac, A. D., & Meadows, G. N. (2024) · Frontiers in Psychology · doi:10.3389/fpsyg.2024.1342592 · Cited by 31 · see citing works
Promoting physical activity for mental health: an updated evidence review and practical guide
McKeon, G., Curtis, J., & Rosenbaum, S. (2022) · Current Opinion in Psychiatry · doi:10.1097/yco.0000000000000796 · Cited by 29 · see citing works
“This evidence is reflected in international treatment guidelines for mood disorders [31].”
BackgroundExperience of antidepressant use and discontinuation: A qualitative synthesis of the evidence
Crowe, M., Inder, M., & McCall, C. (2022) · Journal of Psychiatric and Mental Health Nursing · doi:10.1111/jpm.12850 · Cited by 27 · see citing works
“Despite the high rates of prescribing the evidence of the efficacy of antidepressants is tenuous even though clinical guidelines (Kennedy et al., 2016; Malhi et al., 2021; National Institute for Health and Care Excellence, 2018) recommend their use for moderate to severe depression.”
BackgroundChildhood trauma and depressive symptoms in bipolar disorder: A network analysis
Wrobel, A. L., Cotton, S., Jayasinghe, A., Diaz‐Byrd, C., Yocum, A. K., Turner, A., Dean, O. M., Russell, S. E., Duval, E. R., Ehrlich, T. J., et al. (2023) · Acta Psychiatrica Scandinavica · doi:10.1111/acps.13528 · Cited by 25 · see citing works
Liu, Y., Zhao, G., Guo, J., Qu, H., Kong, L., & Yue, W. (2024) · Journal of Affective Disorders · doi:10.1016/j.jad.2024.09.074 · Cited by 26 · see citing works
Chauhan, M., Parry, R., & Bobo, W. V. (2022) · Neuropsychiatric Disease and Treatment · doi:10.2147/ndt.s279342 · Cited by 25 · see citing works
Sánchez‐Ortí, J. V., Balanzá‐Martínez, V., Correa‐Ghisays, P., Selva‐Vera, G., Vila‐Francés, J., Magdalena‐Benedito, R., Valenzuela, C. S. M., Víctor, V. M., Escribano‐López, I., Hernández‐Mijares, A., et al. (2022) · Acta Psychiatrica Scandinavica · doi:10.1111/acps.13433 · Cited by 24 · see citing works
Psychiatry and/or recovery: a critical analysis
Crowe, M. (2022) · International Journal of Mental Health Nursing · doi:10.1111/inm.13072 · Cited by 24 · see citing works
“The guidelines are highly cited as evidence to support further published opinion and research, and the previous guidelines (Malhi et al. 2021) garnered 742 citations times (Google Scholar August 2022).”
BackgroundFonseca, C., Ettcheto, M., Bicker, J., Fernandes, M. J., Falcão, A. C., Camins, A., & Fortuna, A. C. (2023) · Ageing Research Reviews · doi:10.1016/j.arr.2023.101998 · Cited by 26 · see citing works
Gomes, F. A., Cerqueira, R. O., Lee, Y. L., Mansur, R. B., Kapczinski, F. P., McIntyre, R. S., Yatham, L. N., Berk, M., Milev, R. V., & Brietzke, E. M. (2021) · Journal of Affective Disorders · doi:10.1016/j.jad.2021.11.007 · Cited by 23 · see citing works
When and How to Use Lithium Augmentation for Treating Major Depressive Disorder
Ercis, M., Özerdem, A., & Singh, B. (2023) · The Journal of Clinical Psychiatry · doi:10.4088/jcp.23ac14813 · Cited by 23 · see citing works
Efficacy of lifestyle medicine on sleep quality: A meta-analysis of randomized controlled trials
Wong, V. W.-H., Ho, F. Y., Wong, Y. S.-H., Chung, K., Yeung, W., Ng, C. H., & Sarris, J. J. (2023) · Journal of Affective Disorders · doi:10.1016/j.jad.2023.02.111 · Cited by 21 · see citing works
Mixed Depression: A Mini-Review to Guide Clinical Practice and Future Research Developments
Natale, A., Mineo, L., Fusar‐Poli, L., Aguglia, A., Rodolico, A., Tusconi, M., Amerio, A., Serafini, G., Amore, M., & Aguglia, E. (2022) · Brain Sciences · doi:10.3390/brainsci12010092 · Cited by 22 · see citing works
“Moreover, treatment recommendations for episodes with mixed features are available in the updated editions of some international guidelines for BD: Evidence-based guidelines for treating bipolar disorder: revised third edition recommendations from the British Association for Psychopharmacology (2016; [74]); the Intern…”
BackgroundMethodKahawage, P., Bullock, B., Meyer, D., Gottlieb, J. F., Crowe, M., Swartz, H. A., Yatham, L. N., Inder, M., Porter, R., Nierenberg, A. A., et al. (2022) · The Canadian Journal of Psychiatry · doi:10.1177/07067437221097905 · Cited by 22 · see citing works
Self-citationSørensen, A., Jørgensen, K. J., & Munkholm, K. (2022) · Journal of Affective Disorders · doi:10.1016/j.jad.2022.08.011 · Cited by 22 · see citing works
Teede, H. J., Mousa, A., Tay, C. T., Costello, M., Brennan, L., Norman, R. J., Peña, A. S., Boyle, J. A., Joham, A. E., Berry, L., et al. (2024) · The Medical Journal of Australia · doi:10.5694/mja2.52432 · Cited by 26 · see citing works
Hu, J., McMillan, S. S., Theodoros, T., Collins, J. C., El‐Den, S., O’Reilly, C. L., & Wheeler, A. (2022) · BMC Psychiatry · doi:10.1186/s12888-022-04324-0 · Cited by 21 · see citing works
“Co-prescription of lithium and lamotrigine, as the use of alternate moodstabiliser polypharmacy, is also supported by clinical practice guidelines for bipolar affective disorders [26].”
BackgroundPsychodynamic Psychotherapy for Postpartum Depression: A Systematic Review
Valverde, N., Mollejo, E., Legarra, L., & Gómez, M. L. N. (2023) · Maternal and Child Health Journal · doi:10.1007/s10995-023-03655-y · Cited by 21 · see citing works
Roberts, B., Cooper, Z., Lu, S., Stanley, S., Majda, B. T., Collins, K. R., Gilkes, L., Rodger, J., Akkari, P., & Hood, S. D. (2023) · Frontiers in Pharmacology · doi:10.3389/fphar.2023.1267294 · Cited by 19 · see citing works
“Minor metabolic pathways in parentheses (Cacabelos, 2012; Samer et al., 2013; Malhi et al., 2015; Malhi et al., 2021; Zemanova et al., 2022).”
BackgroundKamp, C. B., Petersen, J. J., Faltermeier, P., Juul, S., Siddiqui, F., Barbateskovic, M., Kristensen, A. T., Moncrieff, J., Horowitz, M. A., Hengartner, M. P., et al. (2024) · BMJ Mental Health · doi:10.1136/bmjment-2023-300730 · Cited by 21 · see citing works
“13 14 The WHO Model List of Essential Medicines also includes the tricyclic antidepressant amitriptyline as one of just two essential antidepressants for the treatment of depressive disorders.”
Yrondi, A., Javelot, H., Nobile, B., Boudieu, L., Aouizerate, B., Llorca, P., Charpeaud, T., Bennabi, D., Antoine Lefrere, A., & Samalin, L. (2024) · L Encéphale · doi:10.1016/j.encep.2023.11.029 · Cited by 22 · see citing works
An, K., Zhang, L., Qiao, R., Li, C., Zhong, Q., Ma, Y., Rao, X., Mao, T., Liu, F., Zhuo, Q., et al. (2022) · Frontiers in Public Health · doi:10.3389/fpubh.2022.914847 · Cited by 20 · see citing works
Jeong, J., Bahk, W., Woo, Y. S., Yoon, B.-H., Lee, J. G., Kim, W., Sohn, I., Park, S., Shim, S.-H., Seo, J. S., et al. (2023) · Clinical Psychopharmacology and Neuroscience · doi:10.9758/cpn.2023.21.1.32 · Cited by 20 · see citing works
“views of current recommendations for diagnosis and management [24].”
InfluentialElectroconvulsive therapy for treatment-resistant depression
Hsieh, M. H. (2023) · Progress in brain research · doi:10.1016/bs.pbr.2023.01.004 · Cited by 20 · see citing works
Gonda, X., Döme, P., Serafini, G., & Pompili, M. (2023) · Pharmacology & Therapeutics · doi:10.1016/j.pharmthera.2023.108390 · Cited by 20 · see citing works
Fagiolini, A. M., Cardoner, N., Pırıldar, Ş., Ittsakul, P., Ng, B., Duailibi, K., & Hindy, N. E. (2023) · Expert Opinion on Pharmacotherapy · doi:10.1080/14656566.2023.2242264 · Cited by 20 · see citing works
“The 2020 clinical practice guidelines for mood disorders by The Royal Australian and New Zealand College of Psychiatrists [45] and the 2016 clinical guidelines for MDD from the Canadian Network for Mood and Axiety Treatments (CANMAT) [44] provide examples of a cluster-based approach, outlining a…”
Aemissegger, V., López‐Alcalde, J., Witt, C. M., & Barth, J. (2022) · Journal of Medical Internet Research · doi:10.2196/36978 · Cited by 19 · see citing works
“Our searches identified a high number of RCTs, which confirms the recent expansion of research into digital interventions [6,43].”
BackgroundInfluentialWrobel, A. L., Jayasinghe, A., Russell, S. E., Marx, W., Alameda, L., Dean, O. M., Cotton, S., Berk, M., & Turner, A. (2021) · Journal of Affective Disorders · doi:10.1016/j.jad.2021.09.103 · Cited by 19 · see citing works
Keskiner, E. Ş., Şahin, E., Topkaya, N., & Yiğit, Z. (2024) · Behavioral Science · doi:10.3390/bs15010006 · Cited by 18 · see citing works
“Moreover, research indicates that anxiety and stress are often situational and related to immediate or future threats, whereas depression is more frequently past-oriented and linked to a sense of loss or failure (Beck et al., 2024; Lopes & Nihei, 2021; Malhi et al., 2021).”
Zhou, S., Xu, Y., Yang, Y., Song, H., Wang, X., & Yu, Y. (2025) · BMC Public Health · doi:10.1186/s12889-025-25044-6 · Cited by 22 · see citing works
Diet and depression: future needs to unlock the potential
Marx, W., Lane, M. M., Hockey, M., Aslam, H., Walder, K. R., Borsini, A., Firth, J., Pariante, C. M., Berding, K., Cryan, J. F., et al. (2021) · Molecular Psychiatry · doi:10.1038/s41380-021-01360-2 · Cited by 18 · see citing works
Korean Medication Algorithm Project for Bipolar Disorder 2022, Fifth Revision: An Executive Summary
Woo, Y. S., Bahk, W., Jeong, J., Lee, J. G., Kim, W., Sohn, I., Park, S., Shim, S.-H., Seo, J. S., Choo, I. H., et al. (2022) · Clinical Psychopharmacology and Neuroscience · doi:10.9758/cpn.2022.20.4.747 · Cited by 17 · see citing works
“asidone, asenapine, and cariprazine that have been recommended in foreign clinical practice guidelines [5,7,36] because they are not available in South Korea.”
BackgroundJoo, S. W., Kim, H., Jo, Y. T., Ahn, S., Choi, Y. J., Choi, W., & Lee, J. S. (2022) · Social Psychiatry and Psychiatric Epidemiology · doi:10.1007/s00127-022-02382-z · Cited by 17 · see citing works
Ng, V. W. S., Leung, M. T. Y., Chan, E. W., Lee, E. H. M., Hayes, J., Osborn, D., Wing, Y. K., Lau, W. C. Y., Man, K. K. C., & Wong, I. C. K. (2023) · Psychiatry Research · doi:10.1016/j.psychres.2023.115236 · Cited by 17 · see citing works
“Lithium is recommended as a first-line treatment of BPD by international clinical guidelines because of its profound efficacy in relieving mood fluctuation and relapse prevention (Malhi et al., 2021; NICE, 2014; Yatham et al., 2018).”
BackgroundEnvironmental Engineering 3.0: Faced with Planetary Problems, Solutions Must Scale-Up Caring
Oerther, D. B., Oerther, S. E., & McCauley, L. (2024) · Journal of Environmental Engineering · doi:10.1061/joeedu.eeeng-7764 · Cited by 16 · see citing works
Practice Guidelines for Bipolar Disorder by the JSMD (Japanese Society of Mood Disorders)
Kato, T., Ogasawara, K., Motomura, K., Kato, M., Tanaka, T., Takaesu, Y., Nio, S., Kishi, T., So, M., Nemoto, K., et al. (2024) · Psychiatry and Clinical Neurosciences · doi:10.1111/pcn.13724 · Cited by 16 · see citing works
Early use of long‐acting injectable antipsychotics in bipolar disorder type I: An expert consensus
Vieta, E., Tohen, M. F., McIntosh, D., Kessing, L. V., Sajatovic, M., & McIntyre, R. S. (2024) · Bipolar Disorders · doi:10.1111/bdi.13498 · Cited by 16 · see citing works
“62 It is important to note that international guidelines may be made obsolete early on if the latest findings are available soon after publication.”
Malhi, G. S., Bell, E., Stavdal, A., Wu, C., Naylor, A., & Kumari, V. (2026) · The Lancet · doi:10.1016/s0140-6736(26)00201-1 · Cited by 16 · see citing works
Self-citationWoo, Y. S., Bahk, W., Seo, J. S., Park, Y., Kim, W., Jeong, J., Shim, S.-H., Lee, J. G., Jang, S.-H., Yang, C.-M., et al. (2022) · Clinical Psychopharmacology and Neuroscience · doi:10.9758/cpn.2022.20.1.37 · Cited by 15 · see citing works
“recommend AD monotherapy for moderate-to-severe depressive episodes without psychotic features [12,14,16,17], and augmentation with AAP is recommended for psychotic depression (Table 2).”
Background
- Authors
- Malhi, G. S., Bell, E., Bassett, D., Boyce, P., Bryant, R., Hazell, P., Hopwood, M., Lyndon, B., Mulder, R., Porter, R., Singh, A. B., & Murray, G.
- Affiliations
- The University of Sydney (AU)
- Consultant Psychiatrist, Perth, WA, Australia
- UNSW Sydney (AU)
- The University of Melbourne (AU)
- University of Otago (NZ)
- Deakin University (AU)
- Swinburne University of Technology (AU)
- Corresponding author
- Malhi, Gin S
- ORCID
- Venue
- Australian & New Zealand Journal of Psychiatry
- Publisher
- SAGE Publications
- Published
- 2020-12-22
- Volume
- 55
- Issue
- 1
- Pages
- 7-117
- ISSN
- 0004-8674 (ISSN-L)
- 1440-1614
- OpenAlex
- W3145708260
- Semantic Scholar
- aebe450498c0d007898716e02f680b40b9ae3f78
- Cited by
- 614
- References
- 648
- Citations by year
- 2026: 115 · 2025: 131 · 2024: 101 · 2023: 117 · 2022: 82 · 2021: 65 · 2020: 3
- FWCI
- 40.01
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Australian & New Zealand Journal of Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Swinburne figshare (Swinburne University of Technology) (submittedVersion)
- Funders
- RANZCP
- Topics
- Health Sciences › Medicine › Pharmacology › Treatment of Major Depression
- Health Sciences › Medicine › Psychiatry and Mental health › Bipolar Disorder and Treatment
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Clinical practice guidelines implementation
- Keywords
- mood disorders, depression, bipolar disorder, depression treatment, bipolar disorder management
- MeSH terms
- Australia, Humans, New Zealand, Psychiatry, Societies, Medical, Practice Guidelines as Topic, Mood Disorders
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
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