NHS offers pre-treatment treatment for depression under new guidelines | depression

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Millions of people in England with mild depression should be offered treatment, exercise, mindfulness or meditation before antidepressants, according to the first new NHS guidelines in more than a decade.

Under the draft guidance, the National Institute for Health and Care Excellence (NICE) recommends that a “list of treatment options” be provided to patients by health professionals before they consider taking the drug.

Currently, antidepressants are offered to people with mild depression or a high-intensity psychological intervention, such as cognitive behavioral therapy (CBT). The change forms part of the first new recommendations to identify, treat and manage depression in adults since 2009.

According to the Office for National Statistics (ONS), one in six (17%) adults has experienced some form of depression this summer. The rate is higher than it was before the pandemic, when 10% of adults contracted it. The bureau found that adults and younger women are more likely to have the infection.

A 2019 review showed that 17% of the adult population in England (7.3 million people) had been prescribed antidepressants in 2017-18.

Dr Paul Crisp, director of the Advice Center in Nice, said: “The COVID-19 pandemic has shown us the impact of depression on the mental health of the nation. People with depression need these evidence-based guidelines recommendations available to the NHS without delay.”

Under the changes, people with “less severe depression,” including those with mild depression, must be involved in conversations with clinicians about what works best for them, but group cognitive behavioral therapy (CBT) can be offered as a first treatment. Cognitive behavioral therapy “focuses on how thoughts, beliefs, attitudes, feelings, and behavior interact, and teaches coping skills to deal with things in life differently.”

This can be followed by offers of seven other treatments including individual CBT, self-help, group exercise, group mindfulness or meditation, before medication is discussed as an option.

Ness said a group exercise would typically include three 60-minute sessions a week for 10 weeks. Instead, patients can opt for group mindfulness or meditation, which Ness said typically consists of eight weekly two-hour sessions and focus on “focusing on the present, observing and sitting with thoughts, feelings, physical sensations, and breathing exercises.”

The guideline adds: “Do not routinely offer antidepressant medication as first-line treatment for less severe depression, unless this is a person’s preference.”

A similar set of psychological interventions, along with the option of antidepressant medication, should be available to those choosing first-line treatment for ‘major depression’.

When considering treatment options, Ness said people should also be encouraged to discuss what may be contributing to their depression, and the patient’s experience with any previous episodes of depression or treatments.

Nav Kapoor, Professor of Psychiatry and Population Health at the University of Manchester and Chair of the Guidelines Committee said: “As a committee, we have made recommendations that we hope will have a real impact on people suffering from depression and their caregivers. We have particularly emphasized the role of patient selection – which It suggests that practitioners should offer people a choice of evidence-based treatments and our understanding that not every treatment is right for every person.”

The guidelines recommend that clinicians discuss mental health waiting lists with patients. It also contains new recommendations for those stopping antidepressants.

Ness said that people considering taking or stopping antidepressant medication should speak with their health care professional about the benefits and risks. Physicians should explain that withdrawal may take weeks or months to complete successfully, that it is usually necessary to reduce the dose in stages over time, and that most people stop taking antidepressants successfully.

Figures from the NHS Business Services show that more than 20 million antidepressants were prescribed between October and December 2020 – an increase of 6% over the same three months in 2019.

“There has been a lot of progress in science and medicine in the past 12 years,” said retired attorney Catherine Rowan, a regular member of the guidelines committee who has served as the caregiver for two family members with depression. “This guideline emphasizes greater patient choice and takes greater account of the things that really matter to patients and their caregivers.”

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