Major depressive disorder – achieving and sustaining remission ACG

Published on 26 March 2025

This ACE Clinical Guideline (ACG) highlights the non-pharmacological and pharmacological management of major depressive disorder (MDD) to achieve remission and reduce the risk of relapse. Specifically, the ACG offers evidence-based recommendations on holistic assessment of MDD severity and patient factors to guide management, treatment of an MDD episode, and maintenance treatment to reduce relapse risk. The ACG focuses on adults (patients 18 years old and above), though brief guideline on other patient groups (including perinatal women as well as children and adolescents) is included.

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Major depressive disorder – achieving and sustaining remission (Mar 2025) [PDF]

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Major depressive disorder – achieving and sustaining remission (Mar 2025) [WEB]

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ACG recommendations

1. Evaluate MDD severity based on

   • Symptom profile,

   • Functional impairment, and

   • Risk of harm (to self or others).

2. Personalise the treatment approach based on MDD severity and other patient factors.

3. For patients with mild to moderate MDD, offer psychological treatment over antidepressants where feasible and acceptable.

4. For patients with moderately severe or severe MDD:

   1. Offer a combination of a second-generation antidepressant with psychotherapy, or psychotherapy alone.

   2. Consider a second-generation antidepressant when psychotherapy is not feasible or acceptable.

5. If response to initial treatment is suboptimal, assess possible reasons before adjusting management strategy.

6. Continue treatment after remission to reduce relapse risk; if antidepressants are prescribed, continue at optimal dose for at least 6 months after remission.

Refer to the Evidence-to-Recommendation (EtR) framework below for a summary of the factors underpinning the ACG’s recommendations.

ACG references and EtR framework

Click below to see the list of references for the major depressive disorder ACG.

Major depressive disorder – achieving and sustaining remission references (Mar 2025) [PDF]

The Evidence-to-Recommendation (EtR) framework is a document that outlines the underpinning evidence and rationale for the recommendations in our ACGs. Download the major depressive disorder EtR framework below to learn more about factors that have informed the strength of the ACG recommendations, including certainty of evidence, clinical benefit/risk balance, local resource implications, feasibility considerations, patient preferences and values.

Major depressive disorder – achieving and sustaining remission EtR framework (Mar 2025) [PDF]