Literature Search

A consistent and defined literature search process is used in the development and revision of ICSI guidelines. Two literature searches were conducted for this guideline.

The first search included systematic reviews, meta-analyses, randomized controlled trials and observational studies from January 2013 – February 2015. The search was limited to adults over 18 years of age. The terms included screening; patient health questionnaire-9 (PHQ-9); insomnia; therapeutic alliance in depressed patients; psychotherapies; antidepressants; implementation and best practices; special populations and disparities; telepsychiatry and outcomes; complementary medicine; integrated care, coordinated care, collaborative care; continuity of patient care, follow-up, office visits and frequency; effective treatments for adults with major depression who also have diabetes; prevalence and treatment of depression in patients who had stroke; after care; follow-up; remission; remission induction; functional impairment; cognitive impairment; genomics, genetics and pharmacogenetics; shared decision-making; and TMS (transcranial magnetic stimulation).

The second literature search was specific to treatment recommendations for major depressive disorder and persistent depressive disorder and included systematic reviews, meta-analyses and randomized controlled trials. It covered the period between January 2005 and September 2015 and was limited to adults over 18 years of age. The terms included treatment, treatment outcomes and multiple treatment comparison; psychological treatment and supportive therapy, cognitive behavioral therapy; antidepressant agents, pharmacotherapy and drug therapy; combined treatment; duration of treatment, acute phase, continuation phase, maintenance phase; depression and major depression; dysthymia disorder and persistent depressive disorder, chronic depression and chronic major depression.

In addition to the literature searches, articles were obtained by work group members and ICSI staff. Those vetted by the work group were included in the guideline when appropriate.

GRADE Methodology

ICSI utilizes the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology system.

GRADE has advantages over other systems including the former system used by ICSI. Advantages include:

• development by a widely representative group of international guideline developers;
• explicit and comprehensive criteria for downgrading and upgrading quality of evidence ratings;
• clear separation between quality of evidence and strength of recommendations that includes a transparent process of moving from evidence evaluation to recommendations;
• clear, pragmatic interpretations of strong versus weak recommendations for clinicians, patients and policy-makers;
• explicit acknowledgement of values and preferences; and
• explicit evaluation of the importance of outcomes of alternative management strategies.

GRADE involves systematically evaluating the quality of evidence (high, moderate, low, very low) and developing a strength of recommendation (strong, weak). For more detailed information on GRADE, please go to: http://www.gradeworkinggroup.org/.