NICE to update guidance on depression for first time in a decade

People with depression should be offered a choice of treatment options, according to draft NICE guidance that backs talking therapies for all patients and medication as a first-line option only for those with severe illness.

A therapist talking to a patient
Focus on talking therapies (Photo: People Images/Getty Images)

Draft advice on identification, treatment and management of depression in adults - which could lead to the first NICE update on the condition in 12 years - offers a 'menu of treatment options' to support shared decisions between patients and clinicians.

A guideline committee considered evidence on 'treatment of new depressive episodes, chronic depression, preventing relapse, patient choice, and the organisation of, and access to, mental health services', NICE said.

Patients with less severe depression should be offered treatments including cognitive behavioural therapy (CBT), exercise, counselling or psychotherapy as a first-line option.

Severe depression

Those with more severe depression could be offered a 'similar range of psychological interventions' along with the option of antidepressant medication.

NICE centre for guidelines director Dr Paul Chrisp said: 'People with depression deserve and expect the best treatment from the NHS which is why this guideline is urgently required.

'The COVID-19 pandemic has shown us the impact depression has had on the nation’s mental health. People with depression need these evidence-based guideline recommendations available to the NHS, without delay.'

Data from the Office of National Statistics cited by NICE shows that 17% of people aged 16 and over in Great Britain experienced some form of depression during summer 2021 - a sharp increase from 10% during the nine-month period before the COVID-19 pandemic.

Draft advice

Although demand for care may not be in doubt, concerns remain over the availability of talking therapies recommended as a first-choice option by NICE.

The BMA warned in 2018 that thousands of patients were waiting months to access talking therapies. The Mental Health Foundation charity says 'long waiting lists' remain for NHS treatment in many parts of the country.

Experts have also warned that not all concerns flagged in previous draft versions of the guidance have been addressed. Chief executive of the UK Council for Psychotherapy Sarah Niblock and former president of the Society for Psychotherapy Research UK Dr Felicitas Rost said: 'It is vital that people with depression have access to the right treatment for them.

'While some of our concerns have finally been addressed in the latest draft, including the importance of patient choice in their treatment, others have not, including the unprecedented binary categorisation of depression severity and the use of unproven methods to determine treatment effectiveness.'

Antidepressants

Meanwhile, the guideline also offers advice for patients coming off antidepressants. More than 7m people in England - around one in six of the adult population - were prescribed antidepressants in 2017/18 according to a 2019 report from Public Health England.

The advice says health professionals should discuss benefits and risks of stopping medication with patients, and warn that 'withdrawal may take weeks or months to complete successfully' and will likely need to be tapered down gradually - but that 'most people stop antidepressants successfully'.

Nav Kapur, professor of psychiatry and population health at the University of Manchester and chair of the guideline committee, said: 'This is a broad ranging guideline on depression which has been an enormous challenge to produce. As a committee we have drawn up recommendations that we hope will have a real impact on people who are suffering from depression and their carers.

'In particular we’ve emphasised the role of patient choice – suggesting that practitioners should offer people a choice of evidence-based treatments and understanding that not every treatment will suit every person. We now need stakeholders' help to make the recommendations as good as they can possibly be.'

Consultation on the draft guideline for registered stakeholders is open until 12 January 2022 at nice.org.uk

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