Page 90 - Depression in adults: treatment and management

Depression in adults: treatment and management (NG222)

table, but to also take into account factors which may promote implementation, such as the use of

least intrusive treatments first. However, the committee agreed that choice of therapy should be a
personalised decision and that some people may prefer to use a treatment further down the table
and that this is a valid choice.

As there was a lack of evidence on the effectiveness of peer support, the committee made a

research recommendation on peer support. As there was considerable uncertainty in the evidence
for the effectiveness and cost effectiveness of psychological interventions, the committee made a
further research recommendation to find out if identifying the mode of action of psychological

interventions would allow greater differentiation between the interventions and aid patient choice.

How the recommendations might affect practice How the recommendations might affect practice

The recommendations reflect current practice, but may reduce variation in practice across the
NHS. Commissioners and services will need to ensure that a meaningful choice of all NHS-

recommended therapies is available, and depending on current availability, this may need an
increase in resource use. Initial consultations and assessment may need longer because of the need
for detailed discussions to support informed choice, but a positive choice may improve engagement
and outcomes.

Return to recommendations

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

Recommendation 1.6.1

Why the committee made the recommendation Why the committee made the recommendation

There was good evidence for the effectiveness of combination of CBT with antidepressants,
individual CBT and individual behavioural therapies and these treatments also appeared to be cost
effective, on average, for adults with more severe depression. There was good evidence for the
effectiveness and cost effectiveness of antidepressants (SSRIs, SNRIs, tricyclic antidepressants
[TCAs] and mirtazapine) and the committee agreed that SSRIs and SNRIs should be recommended

as first line because of their tolerability, but for people whose symptoms had responded well to a
TCA in the past and who had no contraindications, a TCA might be preferred. The committee
agreed that mirtazapine should not be included as a first-line option, but the committee decided to

reserve it for use for further-line treatment.

There was some evidence for the effectiveness of counselling and individual problem-solving

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