Page 91 - Depression in adults: treatment and management

Depression in adults: treatment and management (NG222)

therapy, both of which also appeared to be cost effective.

There was some evidence for the effectiveness of IPT and STPP but these treatments did not
appear to be as cost effective, on average, at improving the symptoms of depression. However, the
committee recognised that these treatments may be helpful for some people and so included them
as options as well.

There was some evidence of effectiveness and cost effectiveness for the combination of
acupuncture and antidepressants but the committee were aware this evidence was based on

Chinese acupuncture which is different to Western acupuncture and so these results may not be
applicable to the UK population, so the committee made a research recommendation on
acupuncture and antidepressants.

Both guided self-help and group exercise were, on average, shown to be effective and appeared to

be cost effective, but the committee were concerned that in clinical practice these interventions
may be offered to people with severe depression in whom regular contact with a healthcare
professional may be of benefit, and so advised that the potential advantages of providing other

treatment choices with more therapist contact should be carefully considered first.

In addition to the evidence reviewed, the committee were aware of large-scale and pragmatic trials
that were excluded from the network meta-analysis (because they involved patient populations
that did not meet specific search criteria). However, the results of these studies were largely

consistent with the evidence reviewed and supported the recommendations.

The committee provided details of the treatments in a table to allow a discussion between

healthcare professionals and people with depression about treatment options. This table is
arranged in order of the committee's consensus on the average effectiveness and cost
effectiveness of the treatments (as well as consideration of implementation factors) with the most
effective and cost effective listed at the top of the table, but 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.

How the recommendation might affect practice How the recommendation might affect practice

The recommendation reflects current practice, but may reduce variation in practice across the

NHS. Commissioners and services will need to ensure that a meaningful choice of all 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

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