Contributors

These guidelines could not have been developed without the expertise and assistance of many types of contributors who, together, made the effort feasible. All of those listed here willingly assisted in the intense effort required to develop guidelines on an issue as complex as the appropriate treatment of major depressive disorder. The resulting document reflects the many important interactions that occurred during the guideline development process.

Depression Guideline Panel Members: Biosketches

A. John Rush, MD, Chair

Betty Jo Hay Distinguished Chair in Mental Health

Professor and Vice Chairman for Research, Department of Psychiatry

University of Texas Southwestern Medical Center

Dallas, Texas

Dr. Rush received his BA from Princeton University and his MD from the College of Physicians and Surgeons of Columbia University.

He is currently the Director of the Mental Health Clinical Research Center, an NIMH-funded center studying the biology, psychology, pharmacology, and psychotherapy of mood disorders. Dr. Rush has published extensively on both the psychology and biology of depression. He has received several NIMH grants to study depression and has helped develop and study the efficacy of cognitive therapy in treatment of depressed outpatients. His research has sought to identify biologic and psychological predictors of specific treatment responses, as well as relapse and recurrence. He serves as the Chair of the DSM-IV Work Group on Mood Disorders for the American Psychiatric Association. Fellow of the American College of Psychiatry , the American Psychiatric Association, and the American College of Neuropsychopharmacology. He is Past President of the Society for Psychotherapy Research.

William E. Golden, MD

Director, General Internal Medicine

Associate Professor, Department of Medicine

University of Arkansas for Medical Sciences

Little Rock, Arkansas

Dr. Golden received his AB from Brown University (1975) and his MD from Baylor College of Medicine (1978). He completed his internal medicine residency and chief residency at Rush-Presbyterian St. Luke's Medical Center in Chicago (1983). Dr. Golden is Director of the Quality Assurance Research and Education Center, Director of the Division of General Internal Medicine, and Associate Professor of Medicine at the University of Arkansas for Medical Sciences. He is currently Chairman of the Quality Assurance Committee of University Hospital. He has had several funded projects in quality assurance and has expertise in perioperative care and medical informatics. He has authored more than 40 journal articles and book chapters on perioperative care, medical education, and quality improvement.

Dr. Golden is a trustee of the American Society of Internal Medicine and a member of the board of directors of the American Medical Review Research Center. He serves on the American Medical Association Council on Medical Education and has recently been appointed to the Liaison Committee on Medical Education. He is a member of many internal medicine societies and has served numerous roles in educational activities and policy-making matters for these organizations.

Gladys Walton Hall, PhD, MSW

Associate Professor, School of Social Work

Howard University

Washington, District of Columbia

Dr. Hall received her BS from Morgan State University (1966), MSW from the University of Connecticut (1971), and PhD from the University of Maryland (1982). She recently completed a post-doctoral fellowship at the National Institute of Mental Health (1990).

Dr. Hall teaches clinical social work methods courses and is a licensed clinical social worker with experience in the private and public sectors. Her private practice is in a comprehensive medical setting and includes the treatment of depressed women. She has authored several publications in the area of depression (childhood depression) and served on various professional boards, both national and local (including the D.C. Mental Health Association). Her research focus is on the psychosocial factors related to the co-morbidity of depression and conduct disorder among children.

Col. Moses Herrera, MD

Chief, Primary Care Clinic

Robins Air Force Base Hospital

Robins Air Force Base, Georgia

Dr. Herrera is a Fellow of the American Academy of Family Practice. He has many years of experience in the practice of family medicine, including obstetrics, geriatrics, pediatrics, and adolescent medicine, as well as in short-tenn psychotherapy and in the diagnosis and treatment of depression. He has served on the Mental Health Committee of the American Academy of Family Practice. With his experience, Dr. Herrera can speak with particular regard to the utility of guidelines as they may be applied to family practice in military medicine.

Artie Houston

Consumer Representative

Fort Worth, Texas

Mrs. Houston represents patients (consumers). She has lived successfully with manic-depressive illness, which was diagnosed in 1968. She played a prominent role in the establishment of the National Depressive and Manic-Depressive Association (NDMDA) and served as its executive vice president and president in 1988-89. Mrs. Houston founded the first NDMDA chapter in Tarrant County, Texas, and served as its president for 2 years. She has a background in business and public relations. She served for 15 years as the business director of a large blood center in Fort Worth, Texas. Mrs. Houston has an extensive history of volunteer work in the areas of depression, manic-depressive illness, and hemophilia.

Roger G. Kathol, MD

Professor of Psychiatry and Internal Medicine

University of Iowa Hospitals and Clinics

Iowa City, Iowa

Dr. Kathol received his BA from the University of Kansas (1970) and his MD from the University of Kansas School of Medicine (1974). He completed his residency in internal medicine at the University of Iowa (1978) and his residency in psychiatry at the University of Iowa (1980). He completed a 1-year fellowship in endocrinology at the University of Otago in Wellington, New Zealand (1981).

Dr. Kathol is the director of the combined Internal Medicine/psychiatry Unit and the General Hospital Psychiatry Services at the University of Iowa Hospitals and Clinics. He currently teaches both psychiatrists and internists about the diagnosis and treatment of medical and psychiatric disorders in patients with complex and combined medical/psychiatric difficulties. He has received NIMH and private foundation grants for clinical research on depressive disorders in the medically ill, on endocrine changes in patients with primary depression, and on pharmacokinetic drug interactions. His research has contributed to the understanding of depression in the medically ill, as well as the potential relationship of hypothalamic-pituitary-adrenal axis dysfunction in patients with primary affective disorder.

Dr. Kathol has lectured widely, is on the editorial board of several journals, holds membership on the boards of national organizations, and is published widely in the area of psychiatric pathology as seen in medically ill patients. He is board-certified in both internal medicine and psychiatry , and is a Fellow of the American College of Physicians, the American Psychiatric Association, and the American Academy of Psychosomatic Medicine. He is the current president of the Academy of Clinical Psychiatry and is a founding officer of the Association of Medicine and Psychiatry.

Wayne Katon, MD

Professor of Psychiatry

Chief of Consultation-Liaison Psychiatry

University of Washington Medical School

Seattle, Washington

Dr. Katon received his BA from the University of Vermont (1971) and his MD from the University of Oregon (1976). He completed his residency in psychiatry at the University of Washington (1979).

Dr. Katon is Chief of the Division of Consultation-Liaison at the University of Washington and head of the Psychiatry Liaison Service to Family Medicine at University and Providence Medical Centers. Dr. Katon received the American Academy of Family Practice Award for Excellence in Teaching. He has taught medical students, psychiatric residents, and family medicine practitioners in the area of psychiatric disorders in family practice and primary care. He has received independent NIMH funding for the study of depression and chronic tinnitus, a randomized trial of psychiatric consultation for patients who are high medical service utilizers, and a randomized trial of psychiatric consultation in treatment of major depression in primary care.

Dr. Katon has published widely in the area of psychopathology (depression, panic disorders, and somatization) in the primary care setting. He has authored more than lOO journal articles and chapters and a book commissioned by NIMH entitled Panic Disorder in the Medical Setting. His research has sought to identify the psychological and social factors associated with medically unexplained somatic symptoms (chest pain, back pain, irritable bowel syndrome, tinnitus, pelvic pain, and dizziness). He is a recognized national and international authority on psychiatric disorders in family practice and general internal medicine.

Catherine L. Matchett, MD

Matchett Medical Center, President

Grapevine, Texas

Dr. Matchett is a Fellow of the American Academy of Family Practice in private practice, who serves approximately 3,500 families in the North Texas area. She completed a rotating internship and 2 years in a psychiatry residency, passing the written boards in psychiatry before completing a family practice residency.

Dr. Matchett is Vice President of the Dallas Chapter of the American Academy of Family Practice. She has a strong interest in preventive medicine and patient education. She has developed and lectured on the utilization of patient education materials and educational methods to facilitate detection and recognition of a wide variety of common health problems, including several disorders that are commonly missed or misdiagnosed by primary care physicians, including depression, anxiety disorders, premenstrual syndrome, and headache disorders. These materials are used to engage patient participation in the process of identification and translation of symptoms into a proper diagnosis so that recognized treatment strategies may be employed. There is an assumption that patient compliance with treatment increases when the patient is educated and actively involved in the treatment process.

Frederick Petty, PhD, MD

Associate Professor, Department of Psychiatry

Veterans Administration Medical Center

University of Texas Southwestern Medical Center

Dallas, Texas

Dr. Petty received his PhD from the Georgia Institute of Technology (1971) and his MD from the University of Tennessee (1976). He completed his residency in psychiatry at the University of Iowa (1980).

Dr. Petty is the recipient of a Research Career Development Award from the Department of Veterans Affairs. He was the Director of the Consultation/Liaison Service at both the Iowa City and Dallas Department of Veterans Affairs Medical Centers. He conducts both basic and clinical research on the biology of stress and depression, as well as on biologic markers for alcoholism. Dr. Petty has received independent, peer-reviewed funding to conduct his research from the Veterans Administration Merit Review Board, NIMH, and NIAAA. He has lectured widely to family practice and general internal medicine physicians regarding the differential diagnosis and management of mood disorders. Dr. Petty is Director of the Depression Clinic at the Department of Veterans Affairs Medical Center in Dallas.

Herbert C. Schulberg, PhD

Professor of Psychiatry , Psychology and Medicine

University of Pittsburgh School of Medicine

Pittsburgh, Pennsylvania

Dr. Schulberg received his BA from Yeshiva College (1955), his PhD from Columbia University, and his MS Hygiene from the Harvard School of Public Health (1963). He completed 2 years of pre-doctoral internships in clinical psychology at several Veterans Administration facilities.

Dr. Schulberg is Director of the Primary Care Consultation Program at the Western Psychiatric Institute and Clinic. He is a Fellow of the American Psychological Association, and was previously president of the American College of Mental Health Administration and a Visiting Scientist at the NIMH. He has published more than 125 peer-reviewed articles, chapters, and books that focus on the delivery and evaluation of psychiatric services, as well as the recognition, differential diagnosis, and treatment of depression and other psychiatric disorders in the primary care setting. Dr. Schulberg is a recognized national authority in this area. He has received several NIMH grants that support his research efforts. Presently, Dr. Schulberg is directing an NIMH-funded 4-year study of the clinical efficacy and cost efficiency of various treatments for major depression in primary care practice.

G. Richard Smith, Jr., MD

Professor and Director

Centers for Mental Healthcare Research

V A HSR&D Field Program for Mental Health

University of Arkansas for Medical Sciences

Little Rock, Arkansas

Dr. Smith received his MD from the University of Arkansas (1977), where he completed his residency in psychiatry. He was a Fellow in Psychiatry and Medicine at the University of Rochester (1980-81). He has served as residency director in the Department of Psychiatry at the University of Arkansas. He has published in the areas of alexithymia, somatization disorder, consultation-liaison, and immunology. He has received NIMH and Robert Wood Johnson Foundation research support for studies of somatization disorder and psychosocial disabilities associated with myocardial infarction. He has been developing disease-specific outcome modules for psychiatric conditions.

Dr. Smith currently serves as Chair of the NIMH Initial Review Group on Mental Health Services Research. He is Director of the Centers for Mental Healthcare Research, which include the NIMH Center for Rural Mental Healthcare Research and the Veterans Affairs Field Program for Mental Health.

Gail Wiscarz Stuart, PhD, RN, CS

Associate Professor and Chief, Division of Psychiatric Nursing

Department of Psychiatry and Behavioral Sciences

Professor, College of Nursing

Medical University of South Carolina

Charleston, South Carolina

Dr. Stuart received her MS in psychiatric nursing from the University of Maryland (1973) and her PhD in behavioral sciences from Johns Hopkins University (1985). She is a certified specialist in adult psychiatric and mental health nursing from the American Nurses Association and maintains a private practice of psychotherapy.

Dr. Stuart's clinical and research interests involve the study of depression, anxiety disorders, and mental health care delivery systems. As Chief of the Division of Psychiatric Nursing, in the Department of Psychiatry , Dr. Stuart is responsible for overseeing the clinical inpatient units at the Institute of Psychiatry .She is also the coordinator of the graduate program in psychiatric nursing at the Medical University of South Carolina in Charleston.

Dr. Stuart has received multiple honors and awards for her work from a large number of organizations and is a Fellow of the American Academy of Nursing. She serves on the NIMH Task Force on Psychiatric Nursing and the NIMH Research Resource Panel for the Severely Mentally I11, among other national appointments. Dr. Stuart has been the principal investigator or coinvestigator on several independent research grants, including studies of the pharmacotherapy and childhood environments of patients with panic disorder, bulimia, and depression. She has written several nationally recognized textbooks on psychiatric nursing and has a substantial list of peer-reviewed journal publications in both the areas of psychiatric disorders and the role of nursing in health care delivery .

Reviewing Consultants for Treatment Issues1

Scientific Reviewers2

Hagop S. Akiskal, MD Senior Science Advisor, Office of the Director National Institute of Mental Health Rockville, Maryland Deborah Allen, MD Professor and Chairman Department of Family Medicine Indiana University School of Medicine Indianapolis, Indiana Kenneth Z. Altshuler, MD* Professor and Chairman, Department of Psychiatry University of Texas Southwestern Medical Center Dallas, Texas Aaron T. Beck, MD* Professor, Department of Psychiatry University of Pennsylvania Philadelphia, Pennsylvania W. Eugene Broadhead, MD, PhD, FAAFP Associate Professor, Department of Community and Family Medicine Duke University Medical Center Durham, North Carolina C. Robert Cloninger, MD* Washington University Medical School St. Louis, Missouri Allen I. Frances, MD* Professor and Chairman, Department of Psychiatry Duke University Medical Center Durham, North Carolina T. Byram Karasu, MD Professor of Psychiatry Albert Einstein College of Medicine Bronx Municipal Hospital Center Jacobi Hospital Bronx, New York Donald F. Klein, MD Columbia University, College of Physicians & Surgeons New York, New York Gerald Klerman, MD (deceased) Professor, Department of Psychiatry Director of Research New York Hospital/ Cornell Medical Center Payne Whitney Clinic New York, New York Rodger Kobes, MD, PhD* Timberlawn Psychiatric Hospital University of Texas Southwestern Medical Center Dallas, Texas Helena Chmura Kraemer, PhD Stanford University Stanford California David J. Kupfer, MD Western Psychiatric Institute and Clinic University of Pittsburgh Pittsburgh, Pennsylvania Jerome Levine, MD* Department of Psychiatry (MPRC) University of Maryland School of Medicine Baltimore, Maryland

Ellen Frank, PhD* University of Pittsburgh School of Medicine Western Psychiatric Institute and Clinic Pittsburgh, Pennsylvania Jack Froom, MD Professor, State University of New York at Stony Brook Stony Brook, New York Junius J. Gonzales, MD Chief, Primary Care Research Program Services Research Branch National Institute of Mental Health Rockville, Maryland Frederick K. Goodwill, MD Director, National Institute of Mental Health Bethesda, Maryland Philip S. Holtzman, PhD* Harvard University Cambridge, Massachusetts Neil Jacobson, PhD Professor, Department of Psychology Center for Clinical Research University of Washington Seattle, Washington Lewis L Judd, MD Mary Gilman Marston Professor and Chair, Department of Psychiatry UCSD School of Medicine La Jolla, California William T. McKinney, MD* University of Wisconsin School of Medicine Madison, Wisconsin Kathleen Merikangas, PhD* Yale University School of Medicine New Haven, Connecticut Deborah M. Nadzam, PhD, RN* Associate Director of Outcomes Research and Development Joint Commission on Accreditation of Healthcare Organizations Oak Brook Terrace, Illinois Robert M. Post, MD* National Institute of Mental Health Bethesda, Maryland Lon S. Schneider, MD* University of Southern California School of Medicine Los Angeles, California Myrna M. Weissman, PhD* Columbia University New York, New York Thomas N. Wise, MD Professor of Psychiatry Georgetown University Washington, District of Columbia

2Being listed in this section does not necessarily imply endorsement of the guideline. *Scientific Reviewer, Group II

Organizations and Individuals Providing Peer and Pilot Review3

American Nurses Association Washington, District of Columbia Contact: Karen O'Connor, MA, RN Sandra E. Benter, DNSC, RN, CS Psychotherapy and Consultation Practice Owings Mills, Maryland John M. Davis, MD Illinois State Psychiatric Institute Chicago Illinois David L. Dunner, MD Professor, Department of Psychiatry University of Washington Seattle, Washington William H.M. Finney, MD, MPH Shepherd's Clinic Baltimore, Maryland Terry E. Fitzgerald National Council, Community Mental Health Centers Rockville, Maryland Frederick K. Goodwin, MD Director, National Institute of Mental Health Bethesda, Maryland Edgar Heim, MD Professor and Co-chair Psychiatrische Univ. Poliklinik Bern, Switzerland Shirley Hibbeln Education Consultant National Depressive and Manic-Depressive Association Chicago, Illinois Pharmaceutical Manufacturers Association Health Outcomes Work Group Washington, District of Columbia Contact: Hugh H. Tilson, MD, DrPH Harold Alan Pincus, MD American Psychiatric Association Washington, District of Columbia John B. Reichman, MD American Academy of Clinical Psychiatry Pocatello, Idaho Lorraine Richter, BS Education Chairman National Depressive and Manic-Depressive Association Chicago, Illinois Joseph A. Rogers Mental Health Association of Southeastern Pennsylvania Philadelphia, Pennsylvania

Robert M.A. Hirschfeld, MD Professor and Chairman, Department of Psychiatry University of Texas Medical Branch Galveston, Texas IMCARE Practice Guidelines Network IMCARE (Internal Medicine Center to Advance Research and Education) American Society of Internal Medicine Washington District of Columbia Contact: Bernard M. Rosof, MD, President Betty F. King, Executive Director Harold A. Kaminetzky, MD, FACOG Director, Practice Activities American College of Obstetricians and Gynecologists Washington, District of Columbia Gerald Klerman, MD (deceased) President Association for Clinical Psychosocial Research Don R. Lipsitt, MD President, American Association of General Hospital Psychiatrists Cambridge, Massachusetts Russ Newman, PhD, JD Deputy Executive Director for Professional Practice American Psychological Association Washington, District of Columbia Peter M. Silberfarb, MD Dartmouth Medical School Dartmouth Hitchcock Medical Center Lebanon, New Hampshire Jeff Susman, MD Department of Family Medicine University of Nebraska Medical Center Omaha, Nebraska Robert L. Thomas National Association of Private Psychiatric Hospitals Washington, District of Columbia Joyce E. Thompson, CNM, DrPH, FAAN University of Pennsylvania School of Nursing Philadelphia, Pennsylvania

3Being listed in this section does not necessarily imply endorsement of the guideline.

Organizations and Individuals Providing Additional Scientific, Technical, and Administrative Support

University of Texas Southwestern Medical Center, Dallas, Texas M. Trivedi, MD, Scientific Assistant to the Chair M. White, MM, Project Manager L. Arnold W. Hendrickse, MD, MRCP G. Kramer D. Savage Agency for Health Care Policy and Research, Rockville, Maryland J.J. Clinton, MD, Administrator K. McCormick, PhD, RN, Director, Office of the Forum E. Corrigan C. Crofton, PhD G. Hernandez, RN S. King, MD V. Montgomery K. Pearson, RPh, MPH R. Siegel L. Williams Editorial Associates, Washington, District of Columbia G.Martin Fast Word, Dallas, Texas Health Systems Research, Washington, District of Columbia

MedStat Systems, Inc. Ann Arbor, Michigan Mikalix & Company, Waltham, Massachusetts M. Madison, MPA, and staff Moshman and Associates, Bethesda, Maryland National Institute of Mental Health, Bethesda, Maryland F. Goodwin, MD, Director J. Burke, MD, MPH J. Gonzales, MD A. Leshner, PhD G. Norquist, MD, MSPH National Library of Medicine, Bethesda, Maryland I. Auston, MLS, and staff University of California at Los Angeles, California D. Schriger, MD, MPH University of California at Berkeley, California T.W. Hu, PhD University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania M. McDonald, MFA Washington Consulting Group, Inc., Washington, District of Columbia C.L. Smith

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