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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“…(Abramovitch et al., 2021), and to reflect this, current clinical guidelines recommend cognitive assessments as part of functional recovery planning for various psychological disorders (Catalan et al., 2021; East-Richard et al., 2020; Fett et al., 2022; Green et al., 2020; Malhi et al., 2021).”
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Additional file 1 of Antipsychotic prescribing patterns in Australia: a retrospective analysis
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Häussl, A., Zwigl, I., Stojec, L., Smolak, I. S., Stijic, M., Stross, T. M., Lenger, M., Fellendorf, F. T., Guggemos, S., Schönthaler, E. M. D., et al. (2026) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2025.1661730 · Cited by 1
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“In addition, exercise has also been shown to improve sleep quality in older adults [16], indicating that it may have synergistic positive effects with sleep on depression.”
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“…diminished confidence amongst clinicians (Malhi et al., 2023), widespread use of second-generation antipsychotics which are often used instead of lithium for maintenance treatment (Jauhar and Young, 2019), and lack of commercial support due to not having a medication patent (Malhi et al., 2020).”
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“…stabilization of affective dysregulation, enhancement of neuroplasticity and neurotrophic signaling, regulation of circadian rhythms, and neuroprotective effects mediated through intracellular pathways such as inhibition of glycogen synthase kinase-3 (GSK-3) (Gitlin, 2016; Malhi et al., 2020).”
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“…guidance on stopping antidepressants, the guideline authors acknowledge that their guidance for dose reduction (halve the dose then reduce more slowly ‘according to how the tablet can be divided’ [4]) is ‘not feasible with medications that are encapsulated (e.g., venlafaxine and duloxetine)’.”
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“MDD is characterized by a significant and persistent change in an individual’s emotions, activity and cognition (Malhi et al., 2021).”
Schizoaffective disorder - A conglomerated disorder that needs an amalgamation of ideas
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“…guidelines indi - cating improved outcomes for people with BD require a combination of medication and evidence-based psycho - logical intervention (Malhi et al., 2021; Yatham et al., 2018), there remains a predominance of the biomedical approach, the centrality of pharmacological interventions,…”
Self-citationD’Souza, S., Anns, F., Waldie, K. E., Mulder, R. T., & Rucklidge, J. J. (2026) · Archives of Women s Mental Health · doi:10.1007/s00737-026-01692-4
“For moderate to severe or treatment-resistant depression symptoms, antidepressants alongside psychological interventions are recommended (Austin et al. 2017; Malhi et al. 2021 ).”
Self-citationCastañeda-González, H. O., Magaña‐Ornelas, A., Santiago‐Maury, A. R., López, S. S., Leonor‐Hernández, I. D. J., & Cabello-Rangel, H. (2026) · Brain and Behavior · doi:10.1002/brb3.71351
“Right temporoparietal placement is performed according to the D’Elia method; this position is more suitable for affective disorders as it has fewer cognitive effects (Malhi et al. 2021 ).”
Yeoh, J. M. J., Diaz, A. M., Tamrakar, S. M., Chakraborti, A., Blackfield, A., & Castle, D. J. (2026) · Australasian Psychiatry · doi:10.1177/10398562261441506
“16 Of the antipsychotics, quetiapine and olanzapine were the most widely prescribed, with the majority of these SGA prescriptions being for ‘ off-label ’ or non-formulary indications – most frequently anxiety, agitation, and insomnia.”
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“The usual “course length” for antidepressants in an episode of depression is a maximum of 12 months [2-4], and overprescribing occurs most often when these medications are not appropriately discontinued (termed “legacy prescribing”), when they are no longer clinically necessary, or where they are…”
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“…widespread recognition and is not explicitly included in the guidelines for depression management issued by national and international health organizations, psychiatrists, or multidisciplinary teams may tailor nutritional supplementation based on individual patient assessments (Malhi et al., 2021).”
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“The most common treatment modalities for mental health challenges are psychotherapy and antidepressant medications (15 – 17).”
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Korean Medication Algorithm Project for Bipolar Disorder 2026: Depressive Episode
Jung, Y., Bahk, W., Woo, Y. S., Jeong, J., Seo, J. S., Yang, C.-M., Yoon, S. H., Jon, D., Park, S., Kim, W. B., et al. (2026) · 신경정신의학 · doi:10.4306/jknpa.2026.65.2.122
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Korean Medication Algorithm Project for Bipolar Disorder 2026: Manic Episode
Choi, W.-S., Bahk, W., Woo, Y. S., Jeong, J., Seo, J. S., Yang, C.-M., Yoon, S. H., Jon, D., Park, S., Kim, W. B., et al. (2026) · 신경정신의학 · doi:10.4306/jknpa.2026.65.2.108
Morton, E., Kcomt, A., & Michalak, E. E. (2026) · Journal of Affective Disorders · doi:10.1016/j.jad.2026.122126
Arnaud-Gil, C. A., SánchezdeCarmona, M., Ng, B., Molina-López, A., Fresán, A., Cardó, G. D. L. S., Martínez, D. E. S., de León, J. E. H., FraustoGonzález, J. C., Barrenechea-Quijano, G., et al. (2026) · Neuropsychobiology · doi:10.1159/000551619
“For all of these reasons, current clinical practice guidelines strongly recommend lithium as a first-line maintenance treat-ment for BD [2, 9, 10].”
Wish list from people with lived experience of bipolar disorder - for clinicians and researchers
Busch, C., Ueland, T., Høegh, M. C., Simonsen, C., Aminoff, S. R., Barrett, E. A., Bjella, T. D., Berg, A. O., Melle, I. S., Kreis, I. V., et al. (2026) · Journal of Affective Disorders Reports · doi:10.1016/j.jadr.2026.101114
Othman, S. M. E., Blekkenhorst, L. C., Akpan, A., Ngune, I., McKay, N., Kennedy, A., Armstrong, E., Hunter, M. L., Murray, K., Coleman, M., et al. (2026) · BJPsych Open · doi:10.1192/bjo.2026.12018
“6,12,13 Behavioural activation is a structured psychological intervention that focuses on increasing access to adaptive behaviours, reducing avoidance behaviours that inhibit access to positive reinforcement, and resolving barriers to activation.”
Gao, Y., Zhang, J., Ma, J., & Lyu, Z. (2026) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2026.1871522
Campisi, S. C., Luca, I. D., Zilio, M., Dayal, A., Kinzel, E., & Korczak, D. J. (2026) · Journal of Adolescent Health · doi:10.1016/j.jadohealth.2026.04.018
van Geffen, A., Smit, D., Spijker, J., & Vrijsen, J. N. (2026) · Journal of Affective Disorders · doi:10.1016/j.jad.2026.122192
Rosenbaum, S., McKeon, G., Kurt, G., Lederman, O., Wright, K., Mistry, S. K., Curtis, J., Ward, P. B., Steel, Z., Fibbins, H., et al. (2026) · The Medical Journal of Australia · doi:10.5694/mja2.70251
“…behaviours are among the few strategies that improve both physical [2, 3] and mental [4] health and are recommended in Australian and international guidelines for the management, treatment and prevention of chronic conditions, including depression [5, 6], cardiometabolic disease and obesity [2].”
Early Discontinuation of Antidepressants in Mood and Anxiety Disorders
Aziz, M. A., Maruf, A. A., Bolton, J. M., Kowalec, K., Eltonsy, S., & Leong, C. (2026) · Journal of Clinical Psychopharmacology · doi:10.1097/jcp.0000000000002217
Gorton, J., Pond, E., Joseph, T., & D’Souza, A. N. (2026) · Disability and Rehabilitation · doi:10.1080/09638288.2026.2704460
O’Dea, B., Subotic-Kerry, M., Borchard, T., Parker, B., Vilus, B., Iorfino, F., Whitton, A. E., Harris‐Roxas, B., Wade, T. D., de Valle, M. K., et al. (2026) · Australian Journal of Primary Health · doi:10.1071/py25226
McIntyre, R. S., Kato, M., Thase, M. E., Therrien, F., Marrache, A. M., Ikehara, K., Ardic, F. C., & Boucher, M. (2026) · CNS Drugs · doi:10.1007/s40263-026-01315-7
“To identify clinically relevant adjunctive treatments, the authors assessed several clinical practice guidelines for the treatment of MDD [15–18, 21, 22].”
InfluentialHsu, T., Hsu, C., Thompson, T., Carvalho, A. F., Stubbs, B., Tseng, P., Yang, F.-C., YU, C., Tu, Y., & Liang, C. (2026) · BMJ Mental Health · doi:10.1136/bmjment-2026-302656
Bokhari, S. A., Elnoor, M., Alnor, M. A., & Javaid, S. F. (2026) · International Journal of Bipolar Disorders · doi:10.1186/s40345-026-00434-w
“…and across major international treatment guidelines lithium continues to occupy a privileged position as a first-line maintenance agent for bipolar I disorder (Yatham et al. 2018; Keramatian et al. 2023; Goodwin et al. 2016; Malhi et al. 2020; Institute and for Health and Care Excellence (NICE).”
Psychotherapy vs antidepressants in heart failure: Impact of adherence
IsHak, W. W., Hamilton, M. A., Diniz, M. A., Mirocha, J., Chernoff, R., Hedrick, R., Aronow, H. U., Darwish, T., Messineo, G., Pasini, M., et al. (2026) · Journal of Affective Disorders · doi:10.1016/j.jad.2026.122318
Bazalar, M. A., & Silva, J. D. (2026) · Therapeutic Advances in Psychopharmacology · doi:10.1177/20451253261467607
Shim, I. H., Bahk, W.-M., & Kim, W. (2026) · Springer eBooks · doi:10.1007/978-981-92-1331-3_3
Biological Non-pharmacological Treatments for Bipolar Disorder
Song, M., & Lee, J. (2026) · Springer eBooks · doi:10.1007/978-981-92-1323-8_15
Comparative Analysis of Bipolar Disorder Treatment Guidelines
Yang, C.-M., & Bahk, W.-M. (2026) · Springer eBooks · doi:10.1007/978-981-92-1323-8_14
Obesity and Metabolic Syndrome in Bipolar Disorder
Yoon, S. H., & Woo, Y. S. (2026) · Springer eBooks · doi:10.1007/978-981-92-1323-8_10
McKeon, G., Hira, S., Smith, S., Sheppard-Perkins, M. D., & Darroch, F. (2026) · Community Health Equity Research & Policy · doi:10.1177/2752535x261473558
An Embedded Model of Care to Address Depression in the In‐Home Aged Care Setting
Davison, T. E., Dickins, M., Kelly, J., Bhar, S. S., & Smith, K. L. (2026) · Australian Journal on Ageing · doi:10.1111/ajag.70220
“Lifestyle therapy is recommended in several treatment guidelines for depression [9, 10, 45, 46].”
Traces of Medical Concepts in Medieval Islamic Thought: Ibn Sīnā on Melancholy
Koca, B., & Çalışır, M. (2026) · Cyprus Turkish Journal of Psychiatry and Psychology · doi:10.35365/ctjpp.26.3.15
Psychology students’ intention to use nutrition interventions in future practice
Bush, J., Freer, C. L., & Thomson-Casey, C. (2026) · Australian Psychologist · doi:10.1080/00050067.2026.2709350
“…follows rather than leads practice change (Abbott, 1988; Gieryn, 1983; Wiggins et al., 2022), as demonstrated by the inclusion of nutrition in international mental health-care practice guidelines (Malhi et al., 2021; Marx et al., 2023) and Australian health strategies (Department of Health, 2021).”
Juwita, D. A., Wahyuni, F. S., & Nurazizah, F. (2026) · Journal of Pharmaceutical And Sciences · doi:10.36490/journal-jps.com.v9i3.1540
“For example, aripiprazole and olanzapine were used in depressive phases, despite being more strongly indicated for manic or mixed episodes [9,21].”
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“…and New Zealand College of Psychiatrists guideline similarly places antidepressants within structured, diagnosis-specific treatment pathways for mood disorders, although the present aggregated dispensing data cannot determine guideline concordance or treatment appropriateness (Malhi et al., 2021).”
A Bibliometric Analysis of Research on Depression and Exercise in Older Adults
Yuksel-Haji, C., Nacar, E., & Suner-Keklik, S. (2026) · European Journal of Multidisciplinary Health Sciences · doi:10.51754/ejmhs.1992421
Physical activity promotion by psychologists: recommendations for navigating the code of ethics
Dissanayake, I., Szuhany, K. L., Fassnacht, D. B., Ali, K., Lederman, O., Stubbs, B., Mazzucchelli, T. G., Kinnafick, F., Leach, M. M., Berle, D., et al. (2026) · Australian Psychologist · doi:10.1080/00050067.2026.2724053
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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