HOW TO TREAT RECURRENT DEPRESSIVE DISORDER 2025

HOW TO TREAT RECURRENT DEPRESSIVE DISORDER 2025

GUIDELINES FOR THE DIAGNOSIS AND TREATMENT OF COMMON MENTAL DISORDERS

(Enacted under Decision No. 2058/QĐ-BYT dated May 14, 2020, by the Minister of Health)

Article 21

RECURRENT DEPRESSIVE DISORDER

CHIEF EDITOR

Associate Professor, PhD Nguyễn Trường Sơn

CO-EDITOR

Associate Professor, PhD Lương Ngọc Khuê

PhD Nguyễn Doãn Phương

CONTRIBUTING AUTHORS

PhD Trần Thị Hà An

MSc Trịnh Thị Vân Anh

PhD Vũ Thy Cầm

MSc Trần Mạnh Cường

PhD Nguyễn Văn Dũng

PhD Vương Ánh Dương

PhD Lê Thị Thu Hà

MSc Trần Thị Thu Hà

MSc Phạm Công Huân

MSc Đoàn Thị Huệ

Specialist Doctor II Nguyễn Thị Minh Hương

MSc Vũ Thị Lan

1. Nguyễn Phương Linh

Specialist Doctor II Nguyễn Thị Phương Loan

MSc Bùi Văn Lợi

MSc Nguyễn Thị Phương Mai

PhD Trần Nguyễn Ngọc

MSc Bùi Nguyễn Hồng Bảo Ngọc

MSc Trương Lê Vân Ngọc

MSc Bùi Văn San

PhD Dương Minh Tâm

MSc Phạm Xuân Thắng

MSc Lê Thị Phương Thảo

MSc Lê Công Thiện

MSc Vương Đình Thủy

Associate Professor, PhD Nguyễn Văn Tuấn

Specialist Doctor II Ngô Văn Tuất

MSc Đặng Thanh Tùng

MSc Vũ Sơn Tùng

MSc Cao Thị Ánh Tuyết

MSc Nguyễn Thị Ái Vân

Specialist Doctor II Hồ Thu Yến

MSc Nguyễn Hoàng Yến

CONTRIBUTORS TO EVALUATION AND FEEDBACK

Associate Professor, PhD Nguyễn Thanh Bình

PhD Vũ Thy Cầm

PhD Nguyễn Hữu Chiến

Specialist Doctor II Võ Thành Đông

PhD Lê Thị Thu Hà

Specialist Doctor II Đỗ Huy Hùng

PhD Nguyễn Mạnh Hùng

MSc Nguyễn Trọng Khoa

Specialist Doctor II Ngô Hùng Lâm

Associate Professor, PhD Phạm Văn Mạnh

Specialist Doctor II Trần Ngọc Nhân

PhD Dương Minh Tâm

MSc Đặng Duy Thanh

PhD Vương Văn Tịnh

Specialist Doctor II Lâm Tứ Trung

PhD Lại Đức Trường

PhD Cao Văn Tuân

Associate Professor, PhD Nguyễn Văn Tuấn

SECRETARIAT TEAM

MSc Đặng Thanh Tùng

MSc Trương Lê Vân Ngọc

BA Đỗ Thị Thư

Article 21

RECURRENT DEPRESSIVE DISORDER

I. DEFINITION  

Recurrent depressive disorder, coded under F33 (F33.0–F33.9) in the ICD-10, is characterized by repeated depressive episodes identified as mild (F32.0), moderate (F32.1), severe without psychotic symptoms (F32.2), or severe with psychotic symptoms (F32.3). Unlike bipolar disorder, it lacks independent episodes of elevated mood meeting criteria for hypomania or mania in the patient’s history. Episodes typically last an average of 6 months, with full recovery between episodes in most cases, though a minority (especially in older age) may progress to persistent depression.

II. ETIOLOGY  

The exact cause of recurrent depressive disorder remains debated, with multiple hypotheses explaining its origin and development:  

1. Biological Hypotheses:  

   – Genetics: Hereditary factors play a significant role.  

   – Biogenic Amines: Involves serotonin and catecholamines (noradrenaline, adrenaline, dopamine, acetylcholine). Reduced catecholamine levels at brain synapses are linked to depressive states.  

   – Endocrine Dysregulation: Some suggest depression results from dysfunction in the hypothalamic-pituitary-adrenal axis.  

2. Psychosocial Hypotheses:  

   – Stressful life events and environmental stressors are strongly associated with the onset of depressive episodes, supported by current research.

III. DIAGNOSIS  

1. Definitive Diagnosis (ICD-10)  

1.1. Clinical Features  

– Subtypes of Recurrent Depressive Disorder:  

  – Current Episode Mild (F33.0):  

    – Meets criteria for recurrent depressive disorder (F33) and mild depressive episode (F32.0).  

    – At least two episodes, each lasting 2+ weeks, separated by months without significant mood disturbance.  

    – Somatic symptoms: 4+ out of 8 present.  

  – Current Episode Moderate (F33.1):  

    – Meets criteria for recurrent depressive disorder (F33) and moderate depressive episode (F32.1).  

    – At least two episodes, each lasting 2+ weeks, separated by months without significant mood disturbance.  

    – Somatic symptoms: 4+ out of 8 present.  

  – Current Episode Severe Without Psychotic Symptoms (F33.2):  

    – Meets criteria for recurrent depressive disorder (F33) and severe depressive episode without psychosis (F32.2).  

    – At least two episodes, each lasting 2+ weeks, separated by months without significant mood disturbance.  

    – Somatic symptoms: 4+ out of 8 present.  

  – Current Episode Severe With Psychotic Symptoms (F33.3):  

    – Meets criteria for recurrent depressive disorder (F33) and severe depressive episode with psychosis (F32.3).  

    – At least two episodes, each lasting 2+ weeks, separated by months without significant mood disturbance.  

    – Somatic symptoms: 4+ out of 8 present.  

  – Currently in Remission (F33.4):  

    – Meets prior criteria for recurrent depressive disorder (F33), but current state does not meet criteria for any depressive episode.  

    – At least two prior episodes, each lasting 2+ weeks, separated by months without significant mood disturbance.  

1.2. Ancillary Testing  

– Basic Labs:  

  – Blood: Hematology, biochemistry, microbiology (HIV, HBV, HCV).  

  – Thyroid hormone levels.  

– Imaging/Functional Tests:  

  – Chest X-ray, abdominal ultrasound, transcranial Doppler, thyroid ultrasound.  

  – EEG, ECG, cerebral blood flow, polysomnography, CT/MRI brain (select cases).  

– Psychological Assessments:  

  – Depression scales: Beck, Hamilton, GDS, PHQ-9.  

  – Personality: MMPI, EPI.  

  – Pittsburgh Sleep Quality Index (PSQI).  

  – Anxiety scales: Zung, Hamilton, DASS.  

– Monitoring Tests:  

  – Metabolic effects: Blood glucose, lipids (cholesterol, triglycerides, LDL, HDL) every 3 months.  

  – Leukopenia: Complete blood count monthly.  

  – Liver, kidney function, ECG every 3 months.

2. Differential Diagnosis  

– Somatic Symptom Disorder: Physical complaints predominate without consistent mood disturbance.  

– Schizoaffective Disorder: Includes manic or psychotic symptoms alongside depression.

IV. TREATMENT  

1. Treatment Principles  

– Accurately assess symptom severity, presence of psychosis, and suicidal ideation/behavior.  

– Initiate psychotropic drugs early: antidepressants, with adjunctive antipsychotics, anxiolytics, or mood stabilizers as needed.  

– Select appropriate drug class, type, and dosage based on the patient’s condition. For agitation, suicidal tendencies, or treatment resistance, combine with ECT.  

– Integrate psychotherapy tailored to each case, fostering a supportive clinician-patient relationship to alleviate pessimism and enhance treatment adherence.  

– Prevent recurrence with mood stabilizers or selected antidepressants for 6 months to 2 years.

2. Treatment Framework  

2.1. Pharmacotherapy  

– Antidepressants: Adjust neurotransmitter levels (serotonin, noradrenaline). Effect onset: 7-10 days at therapeutic dose. Non-response to one may not preclude response to another.  

  – Traditional: MAOIs (rarely used due to interactions); TCAs (e.g., Imipramine, Amitriptyline) with anticholinergic effects, used inpatient with monitoring.  

  – Newer Agents: Fewer side effects, faster onset, safer in overdose, minimal interactions.  

    – SSRIs: Fluoxetine, Fluvoxamine, Paroxetine, Sertraline, Citalopram.  

    – SNRIs: Venlafaxine.  

    – NaSSAs: Mirtazapine.  

    – Tianeptine (Stablon): Enhances serotonin reuptake (for excess synaptic serotonin hypothesis).  

– Adjunctive Treatments:  

  – Anxiolytics (e.g., benzodiazepines for short-term anxiety; avoid prolonged use).  

  – Antipsychotics (e.g., Haloperidol, Risperidone, Olanzapine) for psychotic features.  

  – Mood stabilizers (e.g., Carbamazepine, Valproate) for relapse prevention.  

  – Others: Neuroprotectants (piracetam, citicoline, ginkgo biloba, vinpocetine, choline alfoscerate, cinnarizine), anxiolytics/sedatives (etifoxine, zopiclone, eszopiclone, hydroxyzine, beta-blockers), vitamins/minerals.

2.2. Electroconvulsive Therapy (ECT)  

– Preferred for severe depression with suicidal ideation/behavior, treatment resistance, or failure of other therapies.  

– Adhere to contraindications to prevent complications.

2.3. Transcranial Magnetic Stimulation (TMS)  

– Preferred for mild to moderate depression.  

– Follow indications and contraindications to minimize risks.

2.4. Psychosocial Interventions  

– Cognitive-Behavioral Therapy (CBT).  

– Family therapy.  

– Individual therapy.  

– Relaxation/exercise therapy.  

– Mental health education.  

– Combine therapies for optimal outcomes.

3. Specific Treatments  

– Antidepressants: 1-3 agents:  

  – TCAs: Amitriptyline (25-200 mg/day), Clomipramine (50-100 mg/day).  

  – SSRIs: Sertraline (50-300 mg/day), Fluoxetine (20-60 mg/day), Fluvoxamine (50-100 mg/day), Citalopram (20-60 mg/day), Escitalopram (10-20 mg/day), Paroxetine (20-80 mg/day).  

  – SNRIs: Venlafaxine (37.5-225 mg/day), Duloxetine (40-120 mg/day).  

  – NaSSAs: Mirtazapine (15-60 mg/day).  

  – Dopamine-Norepinephrine Reuptake Inhibitors: Bupropion (75-450 mg/day).  

  – Other: Tianeptine (variable efficacy).  

– Antipsychotics: 1-3 agents:  

  – Haloperidol (5-30 mg/day), Chlorpromazine (25-500 mg/day), Levomepromazine (25-500 mg/day), Sulpiride (25-200 mg/day), Risperidone (1-10 mg/day), Olanzapine (5-30 mg/day), Quetiapine (50-800 mg/day), Clozapine (25-900 mg/day), Aripiprazole (5-30 mg/day).  

– Benzodiazepines: 1 agent:  

  – Diazepam (5-30 mg/day), Lorazepam (1-4 mg/day), Clonazepam (1-8 mg/day), Bromazepam (3-6 mg/day).

V. PROGNOSIS AND COMPLICATIONS  

– Most severe complication: Suicidal ideation or behavior.  

– Physical decline possible due to refusal to eat/drink.

VI. PREVENTION  

– No absolute prevention due to complex, intertwined causes.  

– Relative prevention: Educate children early to build resilient personalities, monitor those with family history for early detection/treatment, ensure sustained maintenance therapy to prevent relapse, and support psychosocial rehabilitation for community reintegration.

REFERENCES

Vietnamese

1. Department of Psychiatry, Hanoi Medical University (2016), Lectures on Psychiatry. Medical Publishing House.  
2. Department of Psychiatry, Hanoi Medical University (2000), Organic Mental Disorders. Postgraduate Lecture Series.  
3. Department of Psychiatry & Medical Psychology, Military Medical Academy (2007), Psychiatry and Psychology. People’s Army Publishing House.  
4. Military Medical Academy (2016), Textbook of Psychiatric Disorders. People’s Army Publishing House, Hanoi.  
5. World Health Organization (1992), The International Classification of Diseases, 10th Revision (ICD-10): Mental and Behavioral Disorders. WHO, Geneva, 1992.  
6. World Health Organization (1992),ICD-10 Classification of Mental and Behavioral Disorders: Diagnostic Criteria for Research (translated by the Department of Psychiatry, Hanoi Medical University).  
7. David A., et al. (2010), Geriatric Psychiatry, Medical Publishing House, 2014. Translated by Nguyễn Kim Việt.  
8. Eduard V. (2009), Bipolar Disorder in Clinical Practice, Medical Publishing House, Hanoi.  
9. Kaplan & Sadock (2013), Pervasive Developmental Disorders, Synopsis of Child and Adolescent Psychiatry, Translated book, Medical Publishing House.  
10. Trần Hữu Bình (2016), Textbook of Psychiatric Disorders: Depressive Phase,Medical Publishing House, Hanoi.  
11. Lê Quang Cường (2005), Epilepsy, Medical Publishing House.  
12. Cao Tiến Đức (2017), Epilepsy: Mental Disorders in Epilepsy and Treatment, Medical Publishing House, pp. 9-15.  
13. Trần Viết Nghị (2000), Mental and Behavioral Disorders Due to Psychoactive Substance Use, Department of Psychiatry, Hanoi Medical University.  
14. Trần Viết Nghị, Nguyễn Minh Tuấn (1995), Treatment of Drug Addiction with Psychotropic Medications, Proceedings of the Scientific Conference on Drug Addiction Treatment Methods, Ministry of Health, Institute of Mental Health.  
15. Nguyễn Viết Thiêm (2000), Mental and Behavioral Disorders Due to Psychoactive Substance Use, Department of Psychiatry, Hanoi Medical University, pp. 103-111.  
16. Nguyễn Minh Tuấn (2016), Textbook of Psychiatric Disorders, Medical Publishing House.  
17. Nguyễn Minh Tuấn (2004), Heroin Addiction: Treatment Methods, Medical Publishing House.  
18. Nguyễn Minh Tuấn (2004), Diagnosis and Treatment of Dependence (Addiction), Medical Publishing House.  
19. Nguyễn Kim Việt (2016), Textbook of Psychiatric Disorders, Medical Publishing House, Hanoi.  
20. Nguyễn Kim Việt (2000), Mental and Behavioral Disorders Due to Psychoactive Substance Use,Department of Psychiatry, Hanoi Medical University.  
21. Nguyễn Kim Việt (2000), Organic Mental Disorders, Department of Psychiatry, Hanoi Medical University.  
22. Nguyễn Kim Việt, Nguyễn Văn Tuấn (2016), Textbook of Psychiatric Disorders, Department of Psychiatry, Hanoi Medical University, Medical Publishing House, pp. 74-79.

English

1. The British Association for Psychopharmacology (2011). Evidence-based guidelines for the pharmacological treatment of schizophrenia: recommendations from the British Association for Psychopharmacology. J Psychopharmacol (Oxf), 25(5), 567–620.
2. The National Institute for Health and Care Excellence (NICE) (2014). Psychosis and schizophrenia in adults: prevention and management. NICE guideline. CG178, 5-46.
3. The National Institute for Health and Care Excellence (2014). Bipolar disorder: the assessment and management of bipolar disorder in adults,children and young people in primary and secondary care. September 2014.
4. The National Institute for Health & Care Excellence – NICE (2010). The Treatmentand Management of Depression in Adults (updated edition). National Clinical Practice Guideline 90, 2010.
5. NICE(2012), “Epilepsies: diagnosis and management ”, NICE 
6. Abdul S. K., Manjula M, Paulomi M. S., et al (2013), “Cognitive Behavior Therapy for Patients with Schizotypal Disorder in an Indian Setting: A Retrospective Review of Clinical Data”, the German Journal of Psychiatry, pp 1-7.
7. Addington D., Abidi S., Garcia-Ortega I., et al. (2017). Canadian Guidelines for the Assessment and Diagnosis of Patients with Schizophrenia Spectrum and Other Psychotic Disorders. Can J Psychiatry, 62(9), 594–603.
8. American Psychiatric Association (1994), “Amphetamine-type stimulants” Diagnostic and Statistical Manual of Mental Disorders”, Fourth Edition, DSM-Washington, DC
9. American Psychiatric Association (2013). Alcohol-Related Disorders, Diagnostic and statistical manual of mental disorders DSM-5, American Psychiatric Publishing, 490-503.
10. AmericanPsychiatric Association (2013). Opioid  Diagnostic and statistical manual of mental disorders DSM-5, American Psychiatric.
11. AmericanPsychiatric Association (2013). Diagnostic and statistical manual of mental disorders DSM-IV.
12. Apurv K., Pinki D., Abdul K. (1997), “Treatment of acute and transient psychoticdisorders with low and high doses of oral haloperidol”, Indian Journal of Psychiatry, pp 2-8
13. American psychiatric association (2010). Practice guideline for the Treatment of Patients With Schizophrenia, Second Edition. 184.
14. Andreas M. (2012), “Schizoaffective Disorder”, Korean J Schizophr Res, pp 5-12.
15. American Psychiatric Association (1994). The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition.
16. Babalonis S, Haney M, Malcolm R.J, et al (2017). Oral cannabidiol does not produce a signal for abuse liability in frequent marijuana smokers. DrugAlcohol Depend. 172, 9-13.
17. Benjamin J. S, Virginia A. S, Pedro R (2017). Substance-Related Disorders, Kapland & Sadock’s Comprehensive Textbook of Psychiatry, Lippincott Williams & Wilkins, Baltimore, Vol. 1.
18. Benjamin J. S., Virginia A. S. (2007), “Substance-Related Disorders- Amphetamine (or Amphetamine-like) Behavioral Sciences/Clinical Psychiatry ”, Kaplan & Sadock’s Synopsis of Psychiatry 10th Edition, Lippincott Williams & Wilkins (2007)
19. Bergamaschi M.M, Queiroz R.H.C, Zuardi A.W., et al (2011). Safety and side effects of cannabidiol, a Cannabis sativa constituent. Curr Drug Saf. 6(4), 237-249.
20. Benzoni O., Fàzzari G., Marangoni C., Placentino A., Rossi A. (2015), “Treatment of resistant mood and schizoaffective disorders with electroconvulsive therapy: a case series of 264 patients”, Journal of Psychopathology, pp 266-268.
21. Daniel R. R., Larry J. S., et al (2014), “Schizotypal personality disorders: a current review”, New York, pp 1-10.
22. Dervaux A.M. (2010). Influence de la consommation de substances sur l’émergence et l’évolution des troubles psychotiques: le cas du cannabis. La these doctotraie, Universit ´e Pierre et Marie Curie – Paris VI, Paris, France.
23. Dieter S., Steven C. S. (2014). “Drug treatment of epilepsy in adults ”, BMJ, p2-19.
24. Early Psychosis Guidelines Writing Group (2010). Australian clinical guidelines for earlypsychosis 2nd  Natl Cent Excell Youth Ment Health Melb, 2, 4–24.
25. Elisa C., Amir H. C., Peter B. (2009), “Treatment of Schizoaffective Disorder”, Psychiatry (Edgemont),p 15-17.
26. Felix-Martin W., Rafael C., (2016), “Current Treatment of Schizoaffective Disorder According to a Neural Network”, Neural Network. J Cytol Histol, pp 2-5
27. Gary R., Donald A., Wiliam H., et al (2017), “Guideline for the pharmacotherapy of schizophrenia in adul”, The canadian journal of schiatry,pp 605-612.
28. Galletly C., Castle D., Dark F., et al. (2016). Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for themanagement of schizophrenia and related disorders. Aust N Z J Psychiatry, 50(5), 410–472.
29. Gautam S., Jain A., Gautam M., Vahia V. N., et al (2017). Clinical Practice Guidelines for the management of Depression. Indian J Psychiatry;59, Suppl
30. Grunze H., et al. (2009). The World Federation of Societies of Biological Psychiatry (WFSBP) Guidelines for the Biological Treatment of Bipolar
31. Hasan A., Falkai P., Wobrock T., et al. (2012). World Federation of Societies of Biological Psychiatry (WFSBP) Guidelines for Biological Treatment of Schizophrenia, Part 1: Update 2012 on the acute treatment of schizophrenia and the management of treatment resistance. World J Biol Psychiatry, 13(5), 318–
32. Hasan A., Falkai P., Wobrock T., et al. (2013). World Federation of Societies of Biological Psychiatry (WFSBP) Guidelines for Biological Treatment of Schizophrenia,Part 2: Update 2012 on the long-term treatment of schizophrenia and management of antipsychotic-induced side  World J Biol Psychiatry, 14(1), 2–44.
33. JakobsenD., Skyum E., Hashemi N., et al. (2017). Antipsychotic treatment of schizotypy and schizotypal personality disorder: a systematic review. J Psychopharmacol (Oxf), 31(4), 397–405.
34. Jinsoo C., Theo C. M. (2017), “Current Treatments for Delusional Disorder”, Psychiatry, pp 5-20
35. Jonathan K. B., Saeed F. (2012), “Acute and transient psychotic disorders: An overview of studies in Asia”, International Review of Psychiatry, pp 463-466
36. Jochim, J., Rifkin-Zybutz, R., Geddes, J., et al (2019).Valproate for acute mania. Cochrane Database of Systematic Reviews.
37. Kaplan& Sadock’s. Pocket Handbook of Psychiatric Drug Treatment
38. Kennedy S. H., Lam R. W., McIntyre R. S., et al (2016). Canadian Network forMood and Anxiety Treatments (CANMAT) 2016 Clinical Guidelines for the Management of Adults with Major Depressive Disorder. The Canadian Journal of Psychiatry, 61(9), 540–560.
39. Krishna R.P., Jessica C., et al(2014), “Schizophrenia: overview and treatment options”, New York, pp 638-643.
40. Lakshmi N. Y., Sidnay H. K., Saga V. P., et al (2018). Canadian network for mood and anxiety treatments (CANMAT) and international society for bipolar disorders (ISBD) 2018 guidelines for the management of patient with bipolar disorder. Bipolar disorders; 20:97-170
41. Laskshmi N.Y., Sidney H. K. (2017). Kaplan and Sadock’s Comprehensive Textbook of Psychiatry: Pharmacological treatment of depression and bipolar disorders, Wolters Kluwer.
42. Lakshmi N. Y., Sidney H. K., Saga V. P., et al (2018). Canadian network for mood and anxiety treatments (CANMAT) and international society for bipolar disorders (ISBD) 2018 guidelines for the management of patient with bipolar disorder. Bipolar disorders; 20:97-170
43. Loya M., Dubey V., Diwan S., Singh H. (2017), “Acute and transient psychotic disorder and schizophrenia: On a continuum or distinct? A study of cognitive functions”, International Journal of Medicine Research, pp-4-7.
44. Manschrec, Nealia L. K. (2006), “Recent Advances in the Treatment of Delusional Disorder”, The Canadian Journal of Psychiatry, pp-114-118
45. Marcos E. M. B., Hermes M. T. B. (2016), “Schizoaffective Disorder and Depression. A case Study of a patient from ceará, Brazil”, iMedPub Journals, pp1-8
46. Mesut Cetin (2015), “Treatment of Schizophrenia: Past, Present and Future”, Bulletin of Clinical Psychopharmacology, pp 96-98.
47. Michael S., Christina Z., Gerd B., (2011), “Prevalence of delusional disorder among psychiatric inpatients: data from the German hospital register”, Neuropsychiatry, pp 319-322.

48. MIMS neurology & psychiatry disease management guidelines

49. RajivTandon (2018), “Pharmacological Treatment of Schizophrenia 2017-2018 Update Summary”, org, pp 37-40.
50. Robert E., et al (2014). Substance-Related and Addictive Disorders. The AmericainPsychiatric Publishing Textbook of Psychiatry, 6 th, DSM-5 Edition, Bristish Library, USA, 735 – 814.
51. Rong C, Lee Y., Carmona N.E., et al (2017). Cannabidiol in medical marijuana: Research vistas and potential opportunities. Pharmacol Res. 121, 213-8.
52. Skelton M., Khokhar W.A., Thacker S.P. (2015). Treatments for delusional disorder. Cochrane Database Syst Rev.
53. Stahl S.M, Stein D.J, Lerer B (2012). Evidence based pharmacotherapy of illicit substance use disorders, Essential evidence based psychopharmacology
54. Stephen M.S., Dan J.S., Bernard L. (2012). Evidence based pharmacotherapy of illicit substance use disorders, Essential evidence based
55. Stahl S. (2009). Stahl’s essential psychopharmacology: neuroscientific basis and practical implications: Cambridge University Press.
56. Stahl, M. (2013). Stahl’s essential psychopharmacology: neuroscientific basis and practical applications, Cambridge University Press.
57. Vieta, Berk M., Schulze&nbspT. G., et al (2018). Bipolar disorders. Nature Reviews Disease Primers, 4, 18008
58. Update2009 on the Treatment of Acute  The World Journal of Biological Psychiatry. 10(2); 85-116.

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