Page 96 - Depression in adults: treatment and management

Depression in adults: treatment and management (NG222)

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

There was some limited evidence for the effectiveness of psychological therapies in combination

with antidepressants for the treatment of depression in people with a personality disorder, and the
committee were aware that extended duration of use and multidisciplinary support may be
beneficial to improve uptake and adherence. However, the evidence base was very limited, with
small studies of low to very low quality. As a result, the committee were not able to recommend a

specific antidepressant or psychological therapy, but agreed that the choice should be guided by
the person's preference. The committee were also limited by the available data when making
recommendations for different types of personality disorders, as the evidence was for mixed or
non-specified types of personality disorder.

Based on their knowledge and experience, and in accordance with existing NICE guidelines, the
committee were aware that in people with depression and personality disorder, treatment of the
personality disorder by specialist services may lead to an improvement in depression.

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

The recommendations may reduce variation in the treatment offered to people presenting with
depression and personality disorder, and will reinforce current practice to treat people with

personality disorder in a specialist programme.

Return to recommendations

Psychotic depression Psychotic depression

Recommendations 1.12.1 to 1.12.6

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

There was some limited evidence that the combination of an antidepressant and an antipsychotic
may provide some benefits in the treatment of psychotic depression. There was some evidence for
olanzapine and quetiapine, and the committee knew that quetiapine has antidepressant actions as
well as antipsychotic actions and is therefore widely used for psychotic depression. The committee

discussed that combination therapy would not usually be started in primary care and therefore
people who wished to start an antipsychotic, would need a referral to specialist mental health
services. Based on their experience, the committee agreed the effectiveness of this combination
should be monitored and that people should be reviewed regularly, not left on the combination

longer than necessary, and that specialist advice would be needed to determine when the

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