New depression treatments favor a tailored approach and include recommendations for the use of shock therapy and other alternatives, including exercise when people fail to get relief from drugs.

The guidelines, issued on Friday by the American Psychiatric Association, are the first update on depression treatment in more than a decade.

The five-year process of intense review, discussion and thoughtful revision-making has led us to today's release of new guidelines that we believe will improve patient care, Dr. Alan Gelenberg, an Arizona-based psychiatrist who led the group that drafted the guidelines, said in a statement.

We are hopeful these guidelines will lead to improved lives for many patients.

The panel searched more than 13,000 scientific articles published between 1999 and 2006 to craft the new guidelines.

Among the changes, the researchers recommend:

* Doctors should use rating scales to assess their patients' conditions and tailor treatment according to the severity of symptoms. They can adjust various strategies such as medication, healthy behaviors, exercise and therapy.

* For people who repeatedly fail to benefit from drugs, the guidelines recommend use of electro-convulsive or so-called shock therapy, which has the most scientific data supporting its use.

* The recommendations also added newer treatments, including transcranial magnetic stimulation, which uses highly focused, pulsed magnetic fields to restore function to stimulate brain regions linked with depression.

Privately held Neurotonics Inc's NeuroStar device was approved for this use by the U.S. Food and Drug Administration in 2008.

* Researchers also recommend use of vagus nerve stimulation, such as a device made by Cyberonics Inc, which delivers electrical stimulation to the vagus nerve, a major nerve linking the brain to internal organs.

* The guidelines also recommend regular exercise, which studies have shown can reduce depressive symptoms, especially in older adults or those with chronic medical problems.

* They recommend more frequent use of maintenance drug treatment, especially for people whose depression is likely to recur. This is especially important for people who have had three prior episodes of depression or chronic illness.

In a separate report, the U.S. Centers for Disease Control and Prevention said on Thursday that about 9 percent of U.S. adults surveyed in 2006 and 2008 had current symptoms of depression, including 3.4 percent who had symptoms of major depression, in which a person reports having five or more depressive symptoms for at least two weeks.

The survey included more than 235,000 people in 45 states, the District of Columbia and two U.S. territories.

Of these, only 4.8 percent of North Dakota residents were depressed, compared with 14.8 percent of those in Mississippi.

Overall, depression affects more than 13 million U.S. adults each year and costs billions of dollars to treat in costs for treatment, loss of productivity, workers compensation and death.

Arizona Medicine Depression