Authors' objectives:

This report provides guidelines on the management of depression in primary and secondary care.

Authors' recommendations: Key priorities for implementation Screening in primary care and general hospital settings: - Screening should be undertaken in primary care and general hospital settings for depression in high-risk groups for example, those with a past history of depression, significant physical illnesses causing disability, or other mental health problems, such as dementia. Watchful waiting: - For patients with mild depression who do not want an intervention or who, in the opinion of the healthcare professional, may recover with no intervention, a further assessment should be arranged, normally within 2 weeks (watchful waiting). Antidepressants in mild depression: - Antidepressants are not recommended for the initial treatment of mild depression, because the risk-benefit ratio is poor. Guided self-help: - For patients with mild depression, healthcare professionals should consider recommending a guided self-help programme based on cognitive behavioural therapy (CBT). Short-term psychological treatment: - In both mild and moderate depression, psychological treatment specifically focused on depression (such as problem-solving therapy, brief CBT and counselling) of 6 to 8 sessions over 10 to 12 weeks should be considered. Prescription of an SSRI: - When an antidepressant is to be prescribed in routine care, it should be a selective serotonin reuptake inhibitor (SSRI), because SSRIs are as effective as tricyclic antidepressants and are less likely to be discontinued because of side effects. Tolerance and craving, discontinuation/withdrawal symptoms: - All patients prescribed antidepressants should be informed that, although the drugs are not associated with tolerance and craving, discontinuation/withdrawal symptoms may occur on stopping, missing doses or, occasionally, on reducing the dose of the drug. These symptoms are usually mild and self-limiting but can occasionally be severe, particularly if the drug is stopped abruptly. Initial presentation of severe depression: - When patients present initially with severe depression, a combination of antidepressants and individual CBT should be considered as the combination is more cost-effective than either treatment on its own. Maintenance treatment with antidepressants: - Patients who have had two or more depressive episodes in the recent past, and who have experienced significant functional impairment during the episodes, should be advised to continue antidepressants for 2 years. Combined treatment for treatment-resistant depression: - For patients whose depression is treatment resistant, the combination of antidepressant medication with CBT should be considered. CBT for recurrent depression: - CBT should be considered for patients with recurrent depression who have relapsed despite antidepressant treatment, or who express a preference for psychological interventions.

Authors' methods: Clinical guideline

Project Status: Completed

URL for project: http://www.nice.org.uk/page.aspx?o=235213

Year Published: 2004

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: England, United Kingdom

Organisation Name: National Institute for Clinical Excellence

Contact Address: MidCity Place, 71 High Holborn, London WC1V 6NA, UK. Tel: +44 020 7067 5800; Fax: +44 020 7067 5801

Contact Name: nice@nice.nhs.uk

Contact Email: nice@nice.nhs.uk

Copyright: National Institute for Clinical Excellence (NICE)