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This clinical guideline on depression is an updated edition of the previous guidance (published in 2004). It was commissioned by NICE and developed by the National Collaborating Centre for Mental Health, and sets out clear, evidence- and consensus-based recommendations for healthcare staff on how to treat and manage depression in adults.
Depression affects 6% of adults each year and is the leading cause of suicide. Its symptoms can be disabling and its effects pervasive, impacting on not only the individual patient but also on their families and the wider society. The NICE guideline is an invaluable resource enabling healthcare professionals to recognise, assess and offer effective treatments for this common mental health problem, which can become a chronic disorder if inadequately treated.
Many areas of the previous guideline have been updated in this edition. There is a new introduction about depression and current practice, and a new chapter on service user and carer experience of care. The evidence reviews of service models and psychological and psychosocial interventions have all been updated and there is a new emphasis on low-intensity psychosocial interventions and an increased range of effective psychological interventions. The chapters on pharmacological interventions provide more detailed advice on sequencing treatments after limited response to initial interventions. This new edition of the guideline also covers the management of subthreshold depressive symptoms, which was not part of the scope of the previous guideline.
Contents
- GUIDELINE DEVELOPMENT GROUP MEMBERS
- ACKNOWLEDGEMENTS
- 1. PREFACE
- 2. DEPRESSION
- 3. METHODS USED TO DEVELOP THIS GUIDELINE
- 4. EXPERIENCE OF CARE
- 5. CASE IDENTIFICATION AND SERVICE DELIVERY
- 5.1. INTRODUCTION
- 5.2. THE IDENTIFICATION OF DEPRESSION IN PRIMARY CARE AND COMMUNITY SETTINGS
- 5.3. SERVICE DELIVERY SYSTEMS IN THE TREATMENT AND MANAGEMENT OF DEPRESSION
- 5.4. STEPPED CARE
- 5.5. COLLABORATIVE CARE
- 5.6. MEDICATION MANAGEMENT
- 5.7. CRISIS RESOLUTION AND HOME TREATMENT TEAMS
- 5.8. ACUTE DAY HOSPITAL CARE
- 5.9. NON-ACUTE DAY HOSPITAL CARE
- 5.10. NON-STATUTORY SUPPORT
- 5.11. RESEARCH RECOMMENDATION
- 6. INTRODUCTION TO PSYCHOLOGICAL AND PSYCHOSOCIAL INTERVENTIONS
- 7. LOW-INTENSITY PSYCHOSOCIAL INTERVENTIONS
- 8. HIGH-INTENSITY PSYCHOLOGICAL INTERVENTIONS
- 8.1. COGNITIVE BEHAVIOURAL THERAPIES
- 8.2. BEHAVIOURAL ACTIVATION
- 8.3. PROBLEM SOLVING
- 8.4. COUPLES THERAPY
- 8.5. INTERPERSONAL THERAPY
- 8.6. COUNSELLING
- 8.7. SHORT-TERM PSYCHODYNAMIC PSYCHOTHERAPY
- 8.8. RATIONAL EMOTIVE BEHAVIOURAL THERAPY
- 8.9. ECONOMIC MODELLING
- 8.10. FROM EVIDENCE TO RECOMMENDATIONS
- 8.11. RECOMMENDATIONS
- 8.12. RESEARCH RECOMMENDATIONS
- 9. INTRODUCTION TO PHARMACOLOGICAL AND PHYSICAL INTERVENTIONS
- 9.1. INTRODUCTION
- 9.2. DOSE AND DURATION OF ANTIDEPRESSANT TREATMENT: EVIDENCE FROM CLINICAL PRACTICE
- 9.3. LIMITATIONS OF THE LITERATURE: PROBLEMS WITH RANDOMISED CONTROLLED TRIALS IN PHARMACOLOGY
- 9.4. STUDIES CONSIDERED FOR REVIEW – ADDITIONAL INCLUSION CRITERIA
- 9.5. ISSUES AND TOPICS COVERED BY THIS REVIEW
- 9.6. PLACEBO-CONTROLLED RANDOMISED CONTROLLED TRIALS OF ANTIDEPRESSANTS
- 9.7. SELECTIVE SEROTONIN REUPTAKE INHIBITORS VERSUS PLACEBO
- 9.8. TRICYCLIC ANTIDEPRESSANTS VERSUS PLACEBO
- 9.9. FROM EVIDENCE TO RECOMMENDATIONS
- 9.10. RECOMMENDATION
- 10. PHARMACOLOGICAL INTERVENTIONS
- 10.1. INTRODUCTION
- 10.2. USE OF INDIVIDUAL DRUGS IN THE TREATMENT OF DEPRESSION
- 10.3. TRICYCLIC ANTIDEPRESSANTS
- 10.4. SELECTIVE SEROTONIN REUPTAKE INHIBITORS
- 10.5. ESCITALOPRAM
- 10.6. THE THREAD STUDY
- 10.7. MONOAMINE OXIDASE INHIBITORS
- 10.8. THIRD-GENERATION ANTIDEPRESSANTS
- 10.9. ST JOHN’S WORT
- 10.10. HEALTH ECONOMIC EVIDENCE
- 10.11. NETWORK META-ANALYSIS OF NEWER ANTIDEPRESSANTS
- 10.12. ECONOMIC MODEL FOR THE COST EFFECTIVENESS OF PHARMACOLOGICAL INTERVENTIONS FOR PEOPLE WITH DEPRESSION
- 10.13. FROM EVIDENCE TO RECOMMENDATIONS
- 10.14. CLINICAL PRACTICE RECOMMENDATIONS
- 10.15. WHEN TO CHANGE ANTIDEPRESSANT TREATMENT WHEN SYMPTOMS OF DEPRESSION ARE NOT IMPROVING
- 11. FACTORS INFLUENCING CHOICE OF ANTIDEPRESSANTS
- 11.1. INTRODUCTION
- 11.2. THE PHARMACOLOGICAL MANAGEMENT OF DEPRESSION IN OLDER ADULTS
- 11.3. THE EFFECT OF SEX ON ANTIDEPRESSANT CHOICE
- 11.4. THE PHARMACOLOGICAL MANAGEMENT OF DEPRESSION WITH PSYCHOTIC SYMPTOMS
- 11.5. THE PHARMACOLOGICAL MANAGEMENT OF ATYPICAL DEPRESSION
- 11.6. THE PHYSICAL AND PHARMACOLOGICAL MANAGEMENT OF DEPRESSION WITH A SEASONAL PATTERN
- 11.7. DOSAGE ISSUES FOR TRICYCLIC ANTIDEPRESSANTS
- 11.8. ANTIDEPRESSANT DISCONTINUATION SYMPTOMS
- 11.9. THE CARDIOTOXICITY OF ANTIDEPRESSANTS
- 11.10. DEPRESSION, ANTIDEPRESSANTS AND SUICIDE
- 12. THE PHARMACOLOGICAL AND PHYSICAL MANAGEMENT OF DEPRESSION THAT HAS NOT ADEQUATELY RESPONDED TO TREATMENT, AND RELAPSE PREVENTION
- 13. THE MANAGEMENT OF SUBTHRESHOLD DEPRESSIVE SYMPTOMS
- 13.1. INTRODUCTION
- 13.2. PHARMACOLOGICAL INTERVENTIONS FOR SUBTHRESHOLD DEPRESSIVE SYMPTOMS AND PERSISTENT SUBTHRESHOLD DEPRESSIVE SYMPTOMS (DYSTHYMIA)
- 13.3. PSYCHOLOGICAL AND OTHER STRATEGIES FOR THE TREATMENT OF PERSISTENT SUBTHRESHOLD DEPRESSIVE SYMPTOMS (DYSTHYMIA)
- 13.4. FROM EVIDENCE TO RECOMMENDATIONS
- 13.5. RECOMMENDATIONS
- 13.6. RESEARCH RECOMMENDATION
- 14. SUMMARY OF RECOMMENDATIONS
- 14.1. CARE OF ALL PEOPLE WITH DEPRESSION
- 14.2. STEPPED CARE
- 14.3. STEP 1: RECOGNITION, ASSESSMENT AND INITIAL MANAGEMENT
- 14.4. STEP 2: RECOGNISED DEPRESSION – PERSISTENT SUBTHRESHOLD DEPRESSIVE SYMPTOMS OR MILD TO MODERATE DEPRESSION
- 14.5. STEP 3: PERSISTENT SUBTHRESHOLD DEPRESSIVE SYMPTOMS OR MILD TO MODERATE DEPRESSION WITH INADEQUATE RESPONSE TO INITIAL INTERVENTIONS, AND MODERATE AND SEVERE DEPRESSION
- 14.6. TREATMENT CHOICE BASED ON DEPRESSION SUBTYPES AND PERSONAL CHARACTERISTICS
- 14.7. ENHANCED CARE FOR DEPRESSION
- 14.8. SEQUENCING TREATMENTS AFTER INITIAL INADEQUATE RESPONSE
- 14.9. CONTINUATION AND RELAPSE PREVENTION
- 14.10. STEP 4: COMPLEX AND SEVERE DEPRESSION
- 14.11. RESEARCH RECOMMENDATIONS
- 15 APPENDICES
- APPENDIX 1. SCOPE FOR THE DEVELOPMENT OF THE CLINICAL GUIDELINE
- APPENDIX 2. DECLARATIONS OF INTEREST BY GUIDELINE DEVELOPMENT GROUP MEMBERS
- APPENDIX 3. SPECIAL ADVISERS TO THE GUIDELINE DEVELOPMENT GROUP
- APPENDIX 4. STAKEHOLDERS AND EXPERTS WHO SUBMITTED COMMENTS IN RESPONSE TO THE CONSULTATION DRAFT OF THE GUIDELINE
- APPENDIX 5. STAKEHOLDERS AND EXPERTS WHO SUBMITTED COMMENTS IN RESPONSE TO THE PRE-PUBLICATION CHECK
- APPENDIX 6. RESEARCHERS CONTACTED TO REQUEST INFORMATION ABOUT UNPUBLISHED OR SOON-TO-BE PUBLISHED STUDIES
- APPENDIX 7. CLINICAL QUESTIONS
- APPENDIX 8. SEARCH STRATEGIES FOR THE IDENTIFICATION OF CLINICAL STUDIES
- APPENDIX 9. CLINICAL STUDY DATA EXTRACTION FORM
- APPENDIX 10. QUALITY CHECKLISTS FOR CLINICAL STUDIES AND REVIEWS
- APPENDIX 11. THE CLASSIFICATION OF DEPRESSION AND DEPRESSION RATING SCALES/QUESTIONNAIRES
- APPENDIX 12. SEARCH STRATEGIES FOR THE IDENTIFICATION OF HEALTH ECONOMIC EVIDENCE
- APPENDIX 13. QUALITY CHECKLIST FOR ECONOMIC STUDIES
- APPENDIX 14. DATA EXTRACTION FORM FOR ECONOMIC STUDIES
- APPENDIX 15. EVIDENCE TABLES FOR ECONOMIC STUDIES
- APPENDIX 16. CLINICAL EVIDENCE PROFILES
- APPENDIX 17. CLINICAL STUDY CHARACTERISTICS TABLES
- APPENDIX 18. REFERENCES TO STUDIES FROM PREVIOUS GUIDELINE
- APPENDIX 19. CLINICAL EVIDENCE FOREST PLOTS
- APPENDIX 20. CASE IDENTIFICATION INCLUDED AND EXCLUDED STUDIES
- APPENDIX 21. METHODOLOGY FROM PREVIOUS GUIDELINE
- 16 REFERENCES
- 17 ABBREVIATIONS
The views presented in this book do not necessarily reflect those of the British Psychological Society, and the publishers are not responsible for any error of omission or fact. The British Psychological Society is a registered charity (no. 229642).
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- Review Antisocial Personality Disorder: Treatment, Management and Prevention[ 2010]Review Antisocial Personality Disorder: Treatment, Management and PreventionNational Collaborating Centre for Mental Health (UK). 2010
- Review Alcohol-Use Disorders: Diagnosis, Assessment and Management of Harmful Drinking and Alcohol Dependence[ 2011]Review Alcohol-Use Disorders: Diagnosis, Assessment and Management of Harmful Drinking and Alcohol DependenceNational Collaborating Centre for Mental Health (UK). 2011
- Review Borderline Personality Disorder: Treatment and Management[ 2009]Review Borderline Personality Disorder: Treatment and ManagementNational Collaborating Centre for Mental Health (UK). 2009