New Guidelines for Treating Depression Set Out by NICE

Peter Russell

November 23, 2021

The National Institute for Health and Care Excellence (NICE) has updated its treatment guidance for depression in the light of rising cases of declining mental health observed during the COVID-19 pandemic.

In the first update for 12 years, the draft guidelines said that adults with depression should make treatment choices in partnership with a healthcare professional.

Figures published by the Office for National Statistics last month showed that 17% of British adults experienced some form of depression in the summer of 2021 compared with 10% before the pandemic began. Rates are currently stable after peaking at 21% earlier in the year, it said.

Dr Paul Chrisp, Director of the centre for guidelines at NICE, said: "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."

Treatment Menus

The review, developed by an independent NICE committee, covered identifying, treating, and managing depression in people aged 18 and over. It recommended treatments for first episodes of depression, further-line treatments, as well as advice on preventing relapse and managing chronic depression, psychotic depression, and depression with a coexisting diagnosis of personality disorder.

A new 'menu' has been drawn up to guide healthcare professionals, in partnership with their patients, towards picking appropriate treatment options.

Patients with less severe depression could choose from first-line treatment options such as group or individual cognitive behavioural therapy (CBT), group exercise, and mindfulness, through to antidepressants, counselling, and short-term psychodynamic psychotherapy.

However, antidepressants, including selective serotonin reuptake inhibitors, should not be offered routinely as a first-line treatment for people with less severe depression unless they chose the option, NICE said.

For patients with more severe depression, first-line options could include a similar range of psychological interventions, along with the option of antidepressants.

Patient Choice

Healthcare professionals should support the choice of people with experience from previous treatment, unless there were concerns about suitability, the committee decided.

The menu takes the form of a wheel, where health professionals and patients would be guided clockwise through recommended options in order of suitability.

The guidelines also contain new recommendations for people stopping antidepressant medication, including the importance of advice from healthcare professionals that 'tapering' dosage is usually required, but that most patients stop antidepressant use successfully.

'Enormous Challenge'

Nav Kapur, Professor of psychiatry and population health at the University of Manchester, who chaired the guideline committee, said drawing up the guidelines had presented an "enormous challenge".

He added: "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."

Commenting on the new guidelines, Dr David Crepaz-Keay, Head of applied learning at the Mental Health Foundation, said: "Depression is widespread and can be very disabling. There are a number of approaches that can be effective for depression, but we know that different people may respond very differently to these treatments."

"We welcome the emphasis on patient choice in the new guidelines, and particularly the inclusion of a greater range of non-drug treatments like exercise that have benefits beyond depression."

He added that it was important "to ensure that this choice is something everyone is capable of exercising, and recognise existing inequalities in antidepressant prescription and access to a choice of treatments".

Registered stakeholders can take part in the NICE consultation until January 12, 2022.


Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.