NICE recommendations for 'less severe' depression - anti-depressants should not be first-line treatm
PULSE online today (23/11/21) reports that new NICE draft guidance has recommended that GPs do not routinely offer patients with ‘less severe’ depression antidepressants as the first line of treatment.
It said this should only be the case if this is their ‘preference’ and that GPs could first offer alternatives such as cognitive behavioural therapy (CBT), counselling, or group mindfulness, meditation or exercise.
The guidance, published today and currently out for consultation, said: ‘Do not routinely offer antidepressant medication as first-line treatment for less severe depression, unless that is the person’s preference.’
It added that those with ‘more severe’ depression should also be offered a range of different options of first-line treatments, depending on their ‘clinical needs and preference’.
The guidance said that GPs should ‘discuss treatment options with people who have a new episode of less severe depression’ – defined as ‘subthreshold symptoms and mild depression’ – and reach a ‘shared decision’ based on their ‘clinical needs and preferences’.
They should take into account that all treatments listed in the guidance ‘can be used as first-line treatments’, it added.
The options, listed ‘in order of recommended use’, are:
- Group CBT
- Group behavioural activation (BA)
- Individual CBT
- Individual BA
- Self-help ‘with support’
- Group exercise
- Group mindfulness or meditation
- Interpersonal psychotherapy (IPT)
- Selective serotonin reuptake inhibitors (SSRIs)
- Counselling
- Short-term psychodynamic psychotherapy (STPP)
GPs should not prescribe or advise the use of St John’s Wort to those with depression because of ‘uncertainty’ about appropriate doses and persistence of effect and ‘potential serious interactions’ with other drugs, it added.
Those with a new episode of ‘more severe’ depression – defined as ‘moderate and severe depression’ – should also be offered a range of potential first-line treatments with a shared decision reached based on their needs and preference, the guidance said.
Treatment options for ‘more severe’ depression in order of ‘recommended use’ are:
- Combination of individual CBT and an antidepressant
- Individual CBT
- Individual behavioural activation (BA)
- Antidepressant medication, which could be an SSRI, SNRI or ‘other antidepressant if indicated based on previous clinical and treatment history’
- Individual ‘problem-solving’
- Counselling
- Short-term psychodynamic psychotherapy (STPP)
- Interpersonal psychotherapy (IPT)
- Self-help ‘with support’
- Group exercise
GPs should recognise that people with all severities of depression 'have a right to decline treatment', the guidance added.
