VA/DOD Clinical Practice Guideline


Management of Major Depressive Disorder


By the VA/DOD Department of Veterans Affairs

Department of Defense

A continuing education course for 10 ces


is approved by the:

APA - is approved by the American Psychological Association to sponsor continuing education for psychologists. maintains responsibility for this program and its content.
CA BBS - California Board of Behavioral Science accepts our CE Provider Approvals through APA, NASW, and NBCC. Course meets the qualifications for hours of continuing education credit for LMFTs, LCSWs, LPCCs, and/or LEPs as required by the California Board of Behavioral Science
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NAADAC - The Association for Addiction Professionals (#575)
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Texas State Board of Examiners of Professional Counselors (#1761)
The Texas Board of Social Work Examiners (#6246)
maintains responsibility for the program.




In this 10 CE course, Learning Objectives are:

After taking this class, the clinician will be able to:

1. List best practice advice on the care of adults who have a diagnosis of MDD.

2. Identify populations that should be screened for depression.

3. List assessment tools for acute safety risks (e.g., harm to self or others, psychotic features) during the initial assessment and periodically thereafter as needed.

4. List evidence-based psychotherapy methods and psychopharmacology interventions.

5. Enumerate advantages of the collaborative care model for the treatment of Complex MDD.

6. List what to include in patient education about the condition and treatment options, including risks and benefits.

7. Review best practices for treatment interventions (pharmacotherapy, psychotherapies, and somatic therapies) in patients with MDD.

8. List the benefits of assessments which include a measure of symptoms, adherence to medication and psychotherapy, and emergence of adverse effects.

9. Address indications for consultation and referral to specialty care.




To receive credit students must
  • Register for the course (order on-line or call toll-free 888-777-3773), after which you will receive the course material and the post-test.

  • The course consists of reading the VA/DOD Clinical Practice Guideline for The Management Of Major Depressive Disorder which is included as a PDF
  • Pass the post-test

  • Upon passing the test, print out your own certificate of completion!

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Your test will be graded online, so the moment you have passed, you may print out your certificate of completion.

That's it! You are done!


A. Major Depressive Disorder
Depression is a common mental disorder that presents with depressed mood, loss of interest or pleasure in regular activities, decreased energy, feelings of guilt or low self-worth, disturbed sleep or appetite, and poor concentration. Major depressive disorder is the most prevalent and disabling form of depression. In addition to the immediate symptoms of depression, MDD results in poor quality of life overall, decreased productivity, and can increase mortality from suicide. Social difficulties including stigma, loss of employment, and marital conflict as a result of depression can also occur. Anxiety, posttraumatic stress disorder (PTSD), and substance misuse are common co-occurring conditions that may worsen the existing depression and complicate treatment.
Depression is considered to be a largely biological illness but can result from a combination of genetic, biological, environmental, and psychological factors. Trauma, loss of a loved one, a difficult relationship, or any stressful situation may trigger depression, but depression can also occur without an obvious trigger.

B. Depression in the General Population
According to the National Alliance on Mental Illness, an estimated 16 million American adults—almost 7% of the population—had at least one major depressive episode in the past year. Women are 70% more likely than men to experience depression, and young adults aged 18–25 are 60% more likely to have depression than people aged 50 or older.[3] Depressive disorders often start at a young age; they reduce people's functioning and often recur.[4] According to the World Health Organization (WHO), MDD (identified as unipolar depressive disorders by WHO) ranked first worldwide among the leading causes of disability (i.e., aggregate years lived with disability [YLD]).[5]
The incremental economic burden of individuals with MDD was $210.5 billion in 2010, in both direct and indirect costs, compared to $173.2 billion in 2005, an increase of 21.5% over this period.[6] Additionally, co-occurring conditions accounted for a larger percentage of the economic burden of MDD than the MDD itself.
Although depression can be a devastating illness, it often responds to treatment. There are a variety of treatment options available for people with depression including drugs and psychotherapy. Depression is frequently underdiagnosed, however; among people with severe depressive symptoms, for example, only about one-third (35%) had seen a mental health professional for treatment in the past year.[7]

C. Depression in the VA/DoD Populations
Military personnel are prone to depression, at least partially as a result of exposure to traumatic experiences, including witnessing combat and separation from family during deployment or military trainings.[8,9] For example, based on data collected in 2011 from a de-identified cross-sectional survey of active duty soldiers, The Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS) described the 30-day prevalence of MDD as 4.8% compared to less than 1%—five times higher— among a civilian comparison group.[10] A meta-analysis of 25 epidemiological studies estimated the prevalence of recent major depression based on the DSM-IV criteria at rates of 12.0% among currently deployed U.S. military personnel, 13.1% among previously deployed, and 5.7% among those never deployed.[11] However, the 25 studies from which these estimates are drawn described a wide range of prevalences depending on the screening or diagnostic instrument, population, and time period used. Being female, enlisted, 17-25 years old, unmarried, and having had less than a college education were risk factors for depression.[11] In an analysis among current and former U.S. military personnel who were included in the Millennium Cohort Study and observed from July 1, 2001 to December 31, 2008, the risk of suicide increased in men and in those who were depressed.[12]
In fiscal year 2015, among Veterans served by the Veterans Health Administration (VHA), the documented prevalence of any depression (including depression not otherwise specified) was 19.8% while the documented prevalence of MDD only was 6.5%.[13]

III. Scope of the Guideline
This CPG is designed to assist providers in managing patients with MDD. The patient population of interest for this CPG includes adults who are eligible for care in the VHA and DoD healthcare delivery system. It includes Veterans as well as deployed and non-deployed active duty Service Members. It also includes care provided by DoD and VA staff as well as care obtained by the DoD and VA from community partners. This CPG does not provide recommendations for the management of MDD in children or adolescents, or for the management of co-occurring disorders. The CPG also does not consider the management of unspecified depressive disorder, or complicated bereavement or the range of other depressive disorders identified in DSM-5: disruptive mood dysregulation disorder, persistent depressive disorder, premenstrual dysphoric disorder, substance/medication-induced depressive disorder, depressive disorder due to another medical condition, other specified depressive disorder or unspecified depressive disorder (depression not otherwise specified). The principals in this document should be strongly considered when treating these other depressive disorders and in particular, unspecified depressive disorders.

A. Target Population
This guideline applies to adults with MDD being treated in any VA/DoD clinical setting. This includes those newly diagnosed, those receiving ongoing treatment and those with chronic depression.

B. Audiences
The guideline is relevant to all healthcare professionals who treat patients for MDD. This version of the guideline was specifically tailored to be of greatest value to the primary care provider and general mental healthcare provider; thus it includes recommendations on how and when to refer to specialty mental healthcare.

C. Outcomes of Interest
• Improvement in quality of life and social and occupational functioning
• Improvement of symptoms
• Retention (keeping patients engaged in treatment)
• Improvement in co-occurring conditions
• Reduced mortality
• Prevention of recurrence or relapse
 adheres to the American Psychological Association's Ethical Principles of Psychologists. Our courses are carefully screened by our Planning Committee to adhere to APA standards. We also require authors who compose Internet courses specifically for us to follow APA ethical standards. maintains responsibility for the program.


All material included in this course is either in the public domain, or used with express permission.

To read the material, without any post-test or credits go to:


Cost of the 10 CE course is $120, which includes the ebook

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