Page 89 - Depression in adults: treatment and management
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Depression in adults: treatment and management (NG222)



         Treatment for a new episode of less severe depression Treatment for a new episode of less severe depression



         Recommendations 1.5.2 and 1.5.3


         Why the committee made the recommendations Why the committee made the recommendations


         There was good evidence for the effectiveness of group cognitive behavioural therapy (CBT) and

         group behavioural activation (BA) and these treatments were found to likely be the most cost
         effective, on average, for adults with less severe depression. There was also good evidence for the
         effectiveness of individual BA, individual CBT and some evidence for the effectiveness of guided
         self-help, and these interventions were also likely to be cost effective. Therefore, these options

         were provided as alternatives for people who did not wish to participate in group therapy. The
         committee discussed that, in practice, it was logical to offer the least intrusive and least resource
         intensive treatments first, and then step up to other treatments if necessary. For this reason, the
         committee agreed that guided self-help should be considered first for most people with less severe

         depression.


         There was some evidence for the effectiveness of group mindfulness and meditation, group
         exercise, interpersonal psychotherapy (IPT) and antidepressants and they were also cost effective

         so these were recommended as alternative treatments for people who did not wish to receive CBT
         or BA (in a group, individual or self-help format). The committee advised that selective serotonin
         reuptake inhibitors (SSRIs) would be the preferred antidepressants to use in people with less
         severe depression because of their safety and tolerability. The committee discussed that as the

         evidence suggested that some psychological therapies were more effective than antidepressants
         and due to the potential for side effects, medication should not be the default treatment for people
         with less severe depression, unless it was the person's preference to take antidepressants rather
         than engage in a psychological intervention.



         There was some evidence that counselling and short-term psychodynamic psychotherapy (STPP)
         may be effective, but these treatments did not appear to be as cost effective, on average, at
         improving the symptoms of less severe depression. However, the committee recognised that these

         treatments may be helpful for some people and so included them as options as well.


         The committee provided details of the treatments in a table to allow a discussion between
         healthcare professionals and people with depression about treatment options. Apart from the

         advice to use guided self-help first for pragmatic reasons, this table is arranged in order of the
         committee's consensus on the average effectiveness and cost effectiveness of the treatments in
         adults with less severe depression, with the most effective and cost effective listed at the top of the





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