The National Institute for Health and Clinical Excellence (NICE) has today (28 October) published guidance on the treatment and management of depression in adults. This new guideline updates previous NICE guidance on depression (CG23) issued in 2004.
This guideline, produced for NICE by the National Collaborating Centre for Mental Health, makes recommendations on the identification, treatment and management of depression in adults in both primary and secondary care.
Recommendations for those involved in the treatment and management of depression include:
Case identification and recognition - be alert to possible depression (particularly in people with a past history of depression or a chronic physical health problem.
Low-intensity psychosocial interventions - for people with persistent sub threshold depressive symptoms or mild to moderate depression, consider offering one or more of the following interventions, guided by the person’s preference: - Individual guided self-help based on the principles of cognitive behavioural therapy (CBT) - Computerised CBT (CCBT) - A structured group physical activity programme.
Drug treatment - do not use antidepressants routinely to treat persistent sub threshold 2 depressive symptoms or mild depression, but consider them for people with: a past history of moderate or severe depression or initial presentation of sub threshold depressive symptoms that have been present for a long period (typically at least 2 years) or sub threshold depressive symptoms or mild depression that persist(s) after other interventions.
Treatment for moderate or severe depression - for people with moderate or severe depression, provide a combination of antidepressant medication and a high-intensity psychological intervention such as CBT.
Continuation and relapse prevention - support and encourage a person who has benefited from taking an antidepressant to continue medication for at least 6 months after remission of an episode of depression. Discuss with the person that this greatly reduces the risk of relapse and antidepressants are not associated with addiction.
Counselling is now only recommended for people with persistent sub threshold depressive symptoms or mild to moderate depression who decline an antidepressant, CBT, IPT, behavioural activation and behavioural couples therapy.
Professor Steve Pilling Director, National Collaborating Centre for Mental Health; Director, Centre for Outcomes Research and Effectiveness, University College London said: “Depression is a complex disorder which for many people can become chronic with serious long-term consequences for their mental and physical health.
"This is clearly acknowledged in the guideline, which recommends an increased range of effective treatment options. By updating the NICE guideline on the treatment and management of depression, we aim to ensure that patients continue to receive the best possible care, by improving identification of the condition and increasing the choice of treatment.”