Spring 2009

Three Clinical Practice Guidelines Updated

Magellan recently approved updates of three clinical practice guidelines to serve as the evidence-based framework for practitioners’ clinical decision-making for the treatment of patients with:

• Substance Use Disorders
• Major Depressive Disorder
• Eating Disorders.

Substance Use Disorders

We re-adopted the American Psychiatric Association’s (APA) Practice Guideline for the Assessment and Treatment of Patients with Substance Use Disorders, Second Edition (2006), Treating Substance Use Disorders: A Quick Reference Guide (2006) and Guideline Watch (April 2007). Magellan’s Introduction to the adopted guideline includes additional information and/or summarizes key points found in the APA guidelines.

Major Depressive Disorder

We also re-adopted the American Psychiatric Association’s Practice Guideline for the Treatment of Patients With Major Depressive Disorder, Second Edition, and its companion document, the 2005 update, Guideline Watch: Practice Guideline for the Treatment of Patients With Major Depressive Disorder, Second Edition, also by APA. The two documents, along with Magellan’s newly updated Introduction, serve as a framework for clinical decision-making with members who have a depressive disorder.

Magellan updated its Introduction to the Major Depressive Disorder (MDD) guideline to reflect ongoing and recent changes to depression treatment. Changes included:

• Adding information regarding antidepressant medications, including the increased risks of lithium to the fetus and pregnant women, and the avoidance of prescribing paroxetine to pregnant women
• Adding four new studies to the Prevention section
• Adding topical information related to the following special populations:

Women	Maternal offspring and depression Recurrent depression Menopause and hormone replacement therapy Sexual dysfunction.
Elderly	The efficacy of duloxetine and the effects of care management on cancer deaths in the depressed elderly.
Children and Adolescents	The efficacy and risk of reported suicide ideation/attempt of antidepressants in treatment of MDD, obsessive-compulsive disorder (OCD) and non-OCD anxiety disorders in pediatric patients Information on the American Academy of Pediatrics new guidelines for treating adolescent depression in primary care.

 

Eating Disorders

Finally, we recently re-adopted the American Psychiatric Association’s (APA) Practice Guideline for the Treatment of Patients With Eating Disorders, Third Edition (2006).

The APA guideline is based on a literature review through 2004. Magellan conducted a further review of the clinical literature on assessment and treatment of eating disorders published through November 2008. We summarize key relevant recommendations from this more recent literature review in the Magellan Introduction to the adopted guideline.

Use of Guidelines

We encourage you to be familiar with the information in the Magellan Introductions, as well as the information in all guidelines.

All Magellan-adopted clinical practice guidelines are intended to augment, not replace, your sound clinical judgment. However, when you decide to provide care that does not adhere to a Magellan-adopted guideline, be sure that the clinical record reflects that you weighed the recommendations in the guideline against the member’s clinical status and needs, and planned a clinically appropriate course of action.

Obtaining Copies of the APA Guideline

Please visit the Clinical Practice Guideline page of this provider website for information on how to obtain copies of APA guidelines.

Provider Feedback

We welcome your input on our adopted clinical practice guidelines. We will take all suggestions and recommendations into consideration in our next review. Submit comments to your local Magellan provider advisory group or local Magellan medical director, or e-mail comments to Kathleen Frampton at KKFrampton@MagellanHealth.com.