Page 94 - Depression in adults: treatment and management

Depression in adults: treatment and management (NG222)

limited evidence that switching to a different antidepressant or increasing the dose of the

antidepressant may be effective. There was also some evidence that a combination of psychological
therapy and antidepressants was effective so the committee also recommended the use of
combination treatment. Based on the evidence from the review of first-line treatment for more
severe depression, the committee agreed that the psychological interventions that had been
effective and cost effective for first-line treatment of more severe depression could be used for

people whose symptoms had not responded to antidepressants and wished to try a psychological
therapy instead.

There was evidence that combinations of antidepressants, or combinations of an antidepressant
with other treatments (ECT, antipsychotics, lithium, lamotrigine and triiodothyronine), were
effective, but the committee agreed these combinations would need specialist advice.

There was some limited evidence for the use of ECT as further-line treatment, alone or in

combination with exercise, so the committee agreed ECT should remain available as an option for
the further-line treatment of depression in certain situations when there has been no or
inadequate response to other treatment. Based on their knowledge, experience and awareness of

the wider evidence base for ECT, the committee were aware that ECT leads to rapid effects and so
they advised that it should also be considered in other circumstances (not just as further-line
treatment), when a rapid response was needed, and provided some examples of situations where
this might be appropriate. The committee were also aware that there may be people with
depression who have had ECT in the past, know it is effective, and express a preference for it. Based

on their knowledge and experience, and to ensure better patient experience, the committee
reinforced the recommendations about taking into account patient preferences when considering
ECT as a treatment option, in line with their recommendations for other treatment options.

The committee discussed the existing recommendations on the delivery of ECT and agreed these
were still correct and so retained them. However, the committee agreed that there were now
recognised up-to-date standards produced by the Royal College of Psychiatrists which covered the
standards of service provision needed for a safe and effective ECT service, and a recognised ECT

accreditation service (ECTAS), and so the committee recommended that clinics and trusts
delivering ECT should be accredited and should adhere to these standards.

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

The recommendations for further-line treatment reflect current practice, but may reduce variation
in practice across the NHS. The recommendations for ECT should ensure the availability of ECT for
people if it is an appropriate treatment option for them, but reinforce that it is only a treatment

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