Updated NICE Guideline for Depression

The UK National Institute for Health and Care Excellence (NICE) has updated the guideline on management of depression with new recommendations. In the new guideline, depression is classified as “less severe” and “more severe”. More severe includes moderate and severe, and less severe includes mild and sub-threshold depression. Sub-threshold has been defined as just below the cut-off (fewer than five symptoms) on a validated depression scale for the evidence reviews. The recommendations including: Discuss treatment options with people with a new episode of depression, to match the choice of treatment to their needs and preferences. Consider the least intrusive and least resource-intensive available treatment (eg, guided self-help) first for less severe depression. Do not routinely offer antidepressant medication as first line treatment for less severe depression unless that is the person’s preference. Choice of further line treatment should be guided by patient preference and what has been tried already. Consider stepping up to an alternative psychological therapy and/or a different antidepressant. Discuss with people that continuation of antidepressants or psychological therapies after full or partial remission may reduce their risk of relapse and help them stay well. Reach a shared decision on whether to continue a treatment for depression based on their clinical needs and preferences. Discuss with people the potential risks of continuing with antidepressants long term, and how these balance against the risks of depression relapse, including possible side effects and difficulty stopping antidepressants. When stopping antidepressants, advise a relatively long tapering using a proportional (hyperbolic) reduction schedule over months rather than weeks reduces the risk of withdrawal symptoms. Treatment options including: Guided self-help, cognitive behavioral therapy, behavioral activation, exercise, mindfulness and meditation, interpersonal psychotherapy, counselling, short term psychodynamic psychotherapy, individual problem-solving, and antidepressant medication. Source: https://www.bmj.com/