Cited by 614Treatment of Major DepressionBipolar Disorder and TreatmentClinical practice guidelines implementation

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The 2020 Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for mood disorders

Malhi, Gin S, Bell, Erica, Bassett, Darryl, Boyce, Philip, Bryant, Richard, Hazell, Philip, Hopwood, Malcolm, Lyndon, Bill, Mulder, Roger, Porter, Richard, Singh, Ajeet B, Murray, Greg·2021·Australian & New Zealand Journal of Psychiatry

DOI 10.1177/0004867420979353

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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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Reflection on the RANZCP position on the adverse effects of psychotherapy
Allison, S. C., Looi, J. C., Kisely, S. R., & Bastiampillai, T. J. (2024) · Australasian Psychiatry · doi:10.1177/10398562241280362 · Cited by 4
Assessing the efficacy of metacognitive therapy as monotherapy or adjunctive treatment in patient suffering from major depression and dysthimia: A comprehensive review of clinical trials
Zanini, C., Enrico, P., Pescuma, V. N., Favalli, V., Bressi, C., Brambilla, P., & Delvecchio, G. (2024) · Journal of Affective Disorders · doi:10.1016/j.jad.2024.11.050 · Cited by 6
Practical Psychosocial Management for Patients With Bipolar Disorder
Miklowitz, D. J., & Gitlin, M. J. (2024) · American Journal of Psychotherapy · doi:10.1176/appi.psychotherapy.20240028 · Cited by 4
Transcranial Magnetic Stimulation in Pregnancy: Efficacy, Safety, and Future Implications for Perinatal Mental Health Care
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Pharmacological profiling of major depressive disorder-related multimorbidity clusters
Nagy, T., Gonda, X., Gézsi, A., Eszlári, N., Hullám, G., González, R., Mäkinen, H., Paajanen, T. I., Török, D., Gál, Z., et al. (2025) · European Neuropsychopharmacology · doi:10.1016/j.euroneuro.2025.05.007 · Cited by 3
“Although the currently used treatment guidelines (Kendrick et al., 2022; Lam et al., 2024; Malhi et al., 2021) underwent a significant evolution over the past decades, they generally fail to address subtypes of depression and provide minimal guidance on how to address different within-category…”
Exercise interventions for depressive, manic, and anxiety symptoms in bipolar disorder: a systematic review and meta-analysis
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Dynamics of Mental Health and Healthcare Use among Children and Young Adults
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Should clinicians and the general population be concerned about seasonal affective disorder in Australia?
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Brexpiprazole versus placebo or other antidepressive agents for treating depression
Ralovska, S., Koychev, I. G., Marinov, P., Furukawa, T. A., Mulsant, B. H., & Cipriani, A. (2023) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd013866.pub2 · Cited by 4
Mental health problems associated with idiopathic anaphylaxis
Gardner, L. S., Tan, Z., Brown, D. A., Gillis, D., Scott, J. G., & Prentice, R. (2023) · Allergy Asthma and Clinical Immunology · doi:10.1186/s13223-023-00824-0 · Cited by 4
“…of emotional problems, and these could most likely be addressed by mental health education and some easy to implement psychological strategies and lifestyle changes such as regular exercise, improving sleep hygiene, mindfulness, relaxation techniques and restructuring of unhelpful cognitions [29].”
Background
External Evaluation of Population Pharmacokinetics Models of Lithium in the Bipolar Population
Lereclus, A., Boniffay, A., Kallée, G., Blin, O. J., Belzeaux-R, R., Dayan, F., Bénito, S., & Guilhaumou, R. (2023) · Pharmaceuticals · doi:10.3390/ph16111627 · Cited by 4
“To ensure safety and avoid toxic adverse events, international guidelines recommend the close monitoring of concentrations through therapeutic drug monitoring (TDM) [12], even though studies have found that the prevalence of TDM for lithium was low [13,14].”
Background
Does theta burst stimulation have differential benefit for those with melancholic or non-melancholic depression?
Parker, G. B., Tavella, G., Spoelma, M. J., & Sazhin, V. (2024) · Journal of Affective Disorders · doi:10.1016/j.jad.2024.01.190 · Cited by 5
Chronic health conditions and disability are prevalent among community users of a digital mental health service: a scoping survey
Shiner, C. T., Li, I., Millard, M., & Mahoney, A. (2024) · Disability and Rehabilitation Assistive Technology · doi:10.1080/17483107.2024.2389208 · Cited by 4
“…emotions [40–42]. cBt is a first-line psychological treatment for anxiety and depressive disorders that is supported by a robust evidence-base [43,44]. cBt has also been explored to promote psychological adjustment and treat anxiety and depressive symptoms experienced within the context of a…”
Lost in translation? Qualitative interviews with Australian psychedelic‐assisted therapy trial clinicians
Barber, M., Gardner, J., Liknaitzky, P., & Carter, A. (2024) · Psychology and Psychotherapy Theory Research and Practice · doi:10.1111/papt.12545 · Cited by 6
A systematic review of manipulations to pharmaceutical dosage forms used in psychotropic tapering plans
O'Brien, D., Healy, A. M., Harkin, A., & Cadogan, C. A. (2025) · British Journal of Clinical Pharmacology · doi:10.1002/bcp.70082 · Cited by 5
Bipolar disorder: Systematic review of approved psychiatric medications (2008–2024) and pipeline Phase-3 medications
Ramadan, S., Tay, L., Kaur, H., Parrish, T., Abdelmoteleb, S., Totlani, J., Tadros, E., Hirsch, D., Murphy, N., Meyer, A., et al. (2025) · Journal of Affective Disorders · doi:10.1016/j.jad.2025.119778 · Cited by 4
The ‘difficult-to-treat depression’ and the ‘response paradigm’ models: Implications and relevance to patient management
McAllister-Williams, H., Aaronson, S. T., Conway, C., Demyttenaere, K., Fitzgerald, P. B., Loo, C. K. A., Mitchell, P., Rush, A. J., Sackeïm, H. A., & Young, A. H. (2021) · Australian & New Zealand Journal of Psychiatry · doi:10.1177/00048674211013090 · Cited by 4
“Rather than TRD or DTD, adoption of a ‘response perspective’ model (proposed by Malhi et al., 2020b) is recommended (section 9.4, pp. 87– 90).”
MethodInfluential
Randomised controlled trial of Interpersonal and Social Rhythm Therapy and group-based Cognitive Remediation versus Interpersonal and Social Rhythm Therapy alone for mood disorders: study protocol
Douglas, K. M., Inder, M., Crowe, M., Jordan, J., Carlye, D., Lacey, C. J., Beaglehole, B., Mulder, R., Eggleston, K., Donovan, K. A., et al. (2022) · BMC Psychiatry · doi:10.1186/s12888-022-03747-z · Cited by 4
“Patients will be accepted into the trial on any medication regimen, with treating psychiatrists using clinical judgment and the Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for mood disorders to inform medication management decisions [49].”
MethodSelf-citation
Depressão pós-parto e psicose puerperal: uma revisão de literatura
Izoton, R. G., Cattaneo, A., Leite, V. T., Castro, M. G. D. O., Linheiro, C. V., de Albuquerque, S. R. C., de Souza, L. S. C., Rodrigues, B. C., & Lopes, B. A. (2022) · Revista Eletrônica Acervo Saúde · doi:10.25248/reas.e11409.2022 · Cited by 4
Positioning of psychodynamic psychotherapy in the treatment of depression: A comparison of the RANZCP 2020 and NICE 2022 guidelines
Malhi, G. S., Bell, E., Bassett, D. L., Boyce, P. M., Hazell, P., Hopwood, M., Lyndon, B., Mulder, R., Porter, R., & Murray, G. (2023) · Australasian Psychiatry · doi:10.1177/10398562231159329 · Cited by 4
“compared to those made by the recently published NICE guidelines.(1) The latter were chosen because of the rigour with which the evidence was examined and because the time period surveyed overlapped with that examined by the MDcpg(2020).”
ResultSelf-citation
Mind Matters: A Critical Look at Malaysia's Postnatal Depression Policy for Women's Mental Health
Alimuddin, A. S., Shukor, N. A. M., Soh, S. Y., Bon, R. S., Mahmud, A. A., Samad, F. D. A., Ismail, N., & Asiff, M. H. (2023) · Women s Health Reports · doi:10.1089/whr.2023.0027 · Cited by 4
A naturalistic effectiveness study of maintenance therapies for the bipolar disorders
Spoelma, M. J., Leidreiter, J., Bayes, A. J., Jebejian, A., & Parker, G. B. (2023) · Acta Psychiatrica Scandinavica · doi:10.1111/acps.13646 · Cited by 3
“Given the primacy of lithium in treatment recommendations for the bipolar disorders (and especially BP-I), 6,21 – 23 our efficacy finding was consistent with that literature.”
BackgroundResult
The 2020 mood disorders clinical practice guidelines: Translating evidence into practice with both style and substance
Malhi, G. S., Bell, E., Boyce, P. M., Hopwood, M., Murray, G., Mulder, R., Porter, R., Singh, A., & Bassett, D. L. (2021) · Australian & New Zealand Journal of Psychiatry · doi:10.1177/00048674211010233 · Cited by 4
Self-citation
Korean Medication Algorithm Project for Bipolar Disorder 2022: Rapid Cycling
Jeong, J., Bahk, W., Woo, Y. S., Yoon, B.-H., Seo, J. S., Choo, I. H., Yang, C.-M., Kim, W., Lee, J. G., Shim, S.-H., et al. (2022) · 신경정신의학 · doi:10.4306/jknpa.2022.61.3.204 · Cited by 4
What are the real costs of rTMS?
Malhi, G. S., Bell, E., & Mannie, Z. N. (2021) · Australian & New Zealand Journal of Psychiatry · doi:10.1177/00048674211023969 · Cited by 4
Self-citation
Precision in psychiatry—A roadmap to translate neurobiological measures to the clinic
Korgaonkar, M. S. (2021) · Bipolar Disorders · doi:10.1111/bdi.13160 · Cited by 4
Needs and Expectations for the myNewWay Blended Digital and Face-to-Face Psychotherapy Model of Care for Depression and Anxiety (Part 2): Participatory Design Study including Mental Health Professionals
Miller, R. K., O'Moore, K., Kikas, K., Matheson, J.-A. T., Whitton, A. E., Baldwin, P., Li, S., Black, M., Kampel, L., Cockayne, N., et al. (2025) · JMIR Human Factors · doi:10.2196/68789 · Cited by 3
“Depression and anxiety are two of the most prevalent mental disorders globally, and psychothera-pies are currently recommended as first-line treatments for both disorders, either alone or in combination with pharma-cotherapies [4,5].”
Essential Information About Chronobiology and Chronotherapy for the Optimal Care of People With Bipolar Disorders: An Expert Consensus
Crouse, J. J., Loblay, V., Jorm, A., Wong, T. R., de Haan, Z., Gorban, C., Shin, M., Tonini, E., Aiken, C., Alloy, L. B., et al. (2026) · Bipolar Disorders · doi:10.1111/bdi.70141 · Cited by 3
“Some CPGs do indeed give strong attention to chronobiology regarding the aetiology and pathophysiology of BD (e.g., 2020 Royal Australian and New Zealand College of Psychiatrists CPG [31]) whereas others do not.”
Self-citation
Agomelatine bears promising potential in treating bipolar depression– a systematic review
Li, J., Luo, H., & Luo, Q. (2024) · International Journal of Psychiatry in Clinical Practice · doi:10.1080/13651501.2024.2436177 · Cited by 3
“The 2020 Royal Australian and New Zealand College of Psychiatrists guidelines(Malhi et al., 2021) cover a broad spectrum of BD with a focus on long-term treatment.”
Ketamine for unipolar depression: A systematic review of efficacy and safety
Peiris, T. E., Pokhrel, A., & Paudel, Y. (2025) · Australasian Psychiatry · doi:10.1177/10398562251328805 · Cited by 3
Research Trends and Progress in Exercise Interventions for Depression: A Bibliometric Visualization Analysis
Wang, M., Lu, S., Hao, L., Chen, N., & Xia, Y. (2025) · Journal of Multidisciplinary Healthcare · doi:10.2147/jmdh.s529339 · Cited by 3
Dose-response effects of aerobic exercise on reducing depression in patients with chronic illness and comorbid depression: a systematic review and meta-analysis
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The growing divide: Income inequities in access to mental healthcare in Australia
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Ethnopsychopharmacology: Clinical and scientific writing pearls
Leung, J. G. (2023) · Mental Health Clinician · doi:10.9740/mhc.2023.12.276 · Cited by 3
Medications and cognitive risk in Aboriginal primary care: a cross‐sectional study
Holdaway, M., Hyde, Z., Hughson, J., Malay, R., Stafford, A. C., Fulford, K., Radford, K. A., Flicker, L. A., Smith, K., Pond, D. C., et al. (2023) · Internal Medicine Journal · doi:10.1111/imj.16323 · Cited by 4
“31 Prescription of antidepressants over longer periods is relatively common in Australian general practice, which may highlight an opportunity for re-evaluation of treat-ment or deprescribing of antidepressants for some.”
Background
Challenges in the Treatment of Psychotic Bipolar Depression
Pastrana, M. A. C., Flores, J. C. I., & Rothschild, A. J. (2024) · Journal of Clinical Psychopharmacology · doi:10.1097/jcp.0000000000001879 · Cited by 3
Understanding the relationship between childhood abuse and affective symptoms in bipolar disorder: New insights from a network analysis
Wrobel, A. L., Turner, M., Dean, O. M., Berk, M., Sylvia, L. G., Thase, M. E., Deckersbach, T., Tohen, M. F., McInnis, M. G., Kocsis, J. H., et al. (2024) · Psychiatry Research · doi:10.1016/j.psychres.2024.116197 · Cited by 3
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“…antipsychotics necessitate a specific authority code indicating whether the condition being treated is schizophrenia or bipolar affective disorder while lithium is predominantly used for the latter although it also sometimes prescribed for treatment-resistant depression (Malhi et al. , 2021).”
Lithium and lamotrigine for the treatment of bipolar II disorder – a systematic review and meta-analysis of randomized trials
Fredskild, M. U., Bruun, C. F., Vinberg, M., Faurholt‐Jepsen, M., Kessing, L. V., & Munkholm, K. (2025) · Journal of Affective Disorders · doi:10.1016/j.jad.2025.04.125 · Cited by 5
Caregivers’ Perspectives Regarding the Use of Psychotropic Medication in Children and Young Adults: A Systematic Review
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“Many caregivers expressed a strong preference for non-pharmacological treatments, such as psychotherapy, particularly for conditions like mild to moderate depression and anxiety, in line with clinical guidelines (Andrews et al., 2018; Hopkins et al., 2015; Malhi et al., 2021; Walter et al., 2020).”
A meta-analytic review of the within-person association between daily physical activity and sedentary time with subjective wellbeing
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“Consequently, physical activity has been identified by several bodies including the Australian and New Zealand College of Psychiatrists (Malhi et al., 2021), the European Psychiatric Association (Cleare et al., 2015) and the British Association for Psychopharmacology (Stubbs et al., 2018) as an…”
Is Engagement in Physical Activity Related to Its Perceived Mental Health Benefits Among People With Depression and Anxiety? A Population-Scale Survey Study
Onyeaka, H., Zambrano, J., Szlyk, H. S., Celano, C. M., Baiden, P., Muoghalu, C., Enemuo, V., Ayisire, O. E., Huffman, J. C., Torous, J. B., et al. (2022) · American Journal of Lifestyle Medicine · doi:10.1177/15598276221116081 · Cited by 3
Evidenzbasierte stationäre Psychotherapie bipolarer Störungen
Martini, J., Soltmann, B., Herzog, K., Hautzinger, M., Bauer, M., & Pfennig, A. (2023) · Der Nervenarzt · doi:10.1007/s00115-022-01432-w · Cited by 3
Afghanistan National Depression Screening (ANDs) scale: development and psychometric testing
Neyazi, A., Mohammadi, A. Q., Rahimi, B. A., Razaqi, N., Afzali, H., Noormohammadi, M., & Neyazi, M. (2024) · Discover Psychology · doi:10.1007/s44202-024-00172-z · Cited by 3
“Beyond the realm of ordinary mood fluctuations, depression engenders a pervasive impact on cognitive, affective, and behavioral domains, thereby significantly impairing daily functioning [3].”
Early Maladaptive Schemas and Depression in Caregivers of Individuals With Schizophrenia Spectrum and Bipolar Disorders
Karambelas, G. J., Byrne, L. K., Allott, K., Jayasinghe, A., Watson, A., Hasty, M. K., Macneil, C. A., Filia, K., & Cotton, S. (2024) · Clinical Psychology & Psychotherapy · doi:10.1002/cpp.3000 · Cited by 3
Psychosocial functioning and its influencing factors in patients with depression post-remission: Implications for assessment and interventions
Yang, H., Wu, M., Huang, W., Yu, H., Teng, C., Yang, H., Liang, H., Zhang, Y., Wei, Z., Tang, Z., et al. (2024) · Journal of Affective Disorders · doi:10.1016/j.jad.2024.08.210 · Cited by 3
Comparative Short- and Long-Term Effectiveness and Safety of Pramipexole and Aripiprazole Augmentation in Treatment-Resistant Unipolar Depression: An Observational Study
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“Among the different pharmacological strategies proposed for the treatment of TRD, AD augmentation with a second-generation antipsychotic (SGA), mostly aripiprazole, currently has the best evidence of efficacy [7,8], is approved by the FDA, and is recommended by international guidelines [9–11].”
Background
Determinants of Adherence to The Mediterranean Diet and Depressive Symptoms in Turkish Young Adults
Ceylan, J. A., & Gümüş, A. B. (2025) · Journal of Basic and Clinical Health Sciences · doi:10.30621/jbachs.1530196 · Cited by 3
Discovery of Herbal Remedies and Key Components for Major Depressive Disorder Through Biased Random Walk Analysis on a Multiscale Network
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“Current treatment options for MDD—including selective serotonin reuptake inhibitors (SSRIs), serotonin–norepinephrine reuptake inhibitors (SNRIs), and tricyclic antidepressants (TCAs)—are widely recognized as first-line therapies [5–7].”
Psychotropic pharmacogenetics in adult populations: From basic science to clinical trials and health economics – An evidence-based overview for decision makers
Truong, T. T. T., Lago, J., Neil, J., Wilkes, F., Barnes, R., Hopwood, M., & Singh, A. (2025) · Australian & New Zealand Journal of Psychiatry · doi:10.1177/00048674251369625 · Cited by 4
“This delay is thought to be linked to slower metabotropic processes, although the exact mechanism of psychotropic drug efficacy remains unclear, reflecting the complexity of the human brain (Malhi et al., 2021).”
Self-citation
Supporting Maternal and Child Mental Health Through Dietary Changes Focused on the Gut Microbiota
Dawson, S. L., Finlay‐jones, A. L., Ball, L., Rocks, T., & Jacka, F. N. (2022) · Psychiatric Annals · doi:10.3928/00485713-20220126-01 · Cited by 3

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: Malhi, Gin S
Bell, Erica
Boyce, Philip
Bryant, Richard
Hazell, Philip
Hopwood, Malcolm
Mulder, Roger
Porter, Richard
Singh, Ajeet B
Murray, Greg
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
DOI: 10.1177/0004867420979353
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
Licence: journals.sagepub.com/page/policies/text-and-data-mining-license (tdm)
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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