Background: According to the World Health Organization, depression affects more than 300 million people worldwide. Moreover, depression is considered a global burden since it is the leading cause of disability.
Objectives: To assess the methodological rigour and transparency of clinical practice guidelines (CPGs) that recommend pharmacological treatment for depression.
Methods: We conducted a comprehensive search on 12 specific databases for CPGs. Inclusion criteria were CPGs for the treatment of depression in primary care and that comprised pharmacological recommendations for the adult or elderly, written in English, Portuguese or Spanish, and published between 2011 and 2016. CPGs designed for local use or for a specific population were excluded. Two reviewers screened CPGs for eligibility. Discrepancies were resolved through discussion between the reviewers. The methodological rigour and transparency of included CPGs were assessed by three reviewers using the instrument AGREE II. Differences greater or equal to 2 points between reviewers score was considered discrepant. Discrepancies were resolved by consensus between the 3 reviewers. A third reviewer was involved when needed. Overall CPG quality was classified as high, moderate and low with A to C grading (Figure 1).
Results: The search strategy retrieved 38 records, of which 15 were evaluated using the AGREE II (Table 1). Most CPGs were selected from the National Guideline Clearinghouse (NGC), were published in 2016 or 2015 (table 1) and were classified as high A (Figure 2). Domain 1 and 4 presented the greatest medians (Figure 3). The distribution of AGREE II scores can be seen in Figure 4.
Conclusions: Most of the included CPGs presented high quality. However, deficiencies in applicability and editorial independence were found. Besides the good technical quality, it is essential that CPGs become effectively an instrument to support clinical practice. Therefore, CPGs developers should improve the analysis of applicability and editorial transparency.