Page 95 - Depression in adults: treatment and management

Depression in adults: treatment and management (NG222)

option in certain circumstances.

Return to recommendations 1.9.1 to 1.9.9 and 1.13.1 to 1.13.9

Chronic depressive symptoms Chronic depressive symptoms

Recommendations 1.10.1 to 1.10.6, 1.10.8 and 1.10.9

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

There was some evidence for CBT, SSRIs, SNRIs and TCAs for the treatment of chronic depressive

symptoms and some very limited evidence that combinations of psychological therapies and
antidepressants may be more effective, on average, than either alone. As there was such limited
evidence, particularly for older people who may be more susceptible to chronic depression, and for
those whose chronic depression may be because of the impact of social determinants, the

committee made a research recommendation on the effectiveness and cost effectiveness of
psychological, pharmacological or a combination of these treatments.

There was some evidence for the effectiveness of other medications, including TCAs, phenelzine,

amisulpride and moclobemide for people with chronic depression, so the committee considered
these could be used as alternatives with specialist advice in people whose symptoms did not
respond to SSRIs or SNRIs. However, this was an extrapolation of the evidence which was for the
first-line treatment of chronic depression (not further-line). As there was no evidence for the use of

monoamine oxidase inhibitors (MAOIs) for further-line treatment of chronic depression, the
committee made a research recommendation on the effectiveness, acceptability and safety of
MAOIs.

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.

Return to recommendations

Depression in people with a diagnosis of personality Depression in people with a diagnosis of personality

disorder disorder

Recommendations 1.11.1 to 1.11.4

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