The DOI matches its Crossref record; 647 of the 648 references it cites were found in a registry or an index.
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.3,44”
From Clinical practice guideline recommendations on tapering and discontinuing antidepressants for depression: a systematic review (2022) · cites this paper as [3]
In the citing paper
“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]
In the citing paper
“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]
In the citing paper
“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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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 121
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“As with sleep dysfunction, a number of treatment avenues are available for anxiety and depression, both pharmacological and psychological (43, 44).”
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Antidepressant discontinuation syndrome: A state-of-the-art clinical review
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“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 29
“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 33
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 33
“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
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
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
“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 28
“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
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 29
Chauhan, M., Parry, R., & Bobo, W. V. (2022) · Neuropsychiatric Disease and Treatment · doi:10.2147/ndt.s279342 · Cited by 25
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
Psychiatry and/or recovery: a critical analysis
Crowe, M. (2022) · International Journal of Mental Health Nursing · doi:10.1111/inm.13072 · Cited by 26
“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 31
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
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
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 22
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 26
“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 25
Self-citationSørensen, A., Jørgensen, K. J., & Munkholm, K. (2022) · Journal of Affective Disorders · doi:10.1016/j.jad.2022.08.011 · Cited by 23
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
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
“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
Roberts, B., Cooper, Z., Lu, S. Y., Stanley, S. H., Majda, B. T., Collins, K. R. L., Gilkes, L., Rodger, J., Akkari, P. A., & Hood, S. D. (2023) · Frontiers in Pharmacology · doi:10.3389/fphar.2023.1267294 · Cited by 22
“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 23
“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
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
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
“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 26
Gonda, X., Döme, P., Serafini, G., & Pompili, M. (2023) · Pharmacology & Therapeutics · doi:10.1016/j.pharmthera.2023.108390 · Cited by 21
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 21
“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 20
“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
Keskiner, E. Ş., Şahin, E., Topkaya, N., & Yiğit, Z. (2024) · Behavioral Science · doi:10.3390/bs15010006 · Cited by 18
“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
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
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
“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
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 18
“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
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 18
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
“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 17
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
“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
Metadata
- 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 (medical) › 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
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