Main description:

Depression affects 6% of adults each year and is the leading
cause of suicide. Its symptoms can be disabling and its effects pervasive,
impacting on not only the individual patient but also on their families and the
wider society. This book is an invaluable resource enabling healthcare
professionals to recognise, assess and offer effective treatments for this
common mental health problem, which can become a chronic disorder if
inadequately treated.

This updated guideline includes new sections on: current
practice; service user and carer experiences; emphasis on low-intensity
psychosocial interventions and an increased range of effective psychological
interventions; and the management of subthreshold depressive symptoms.

This guideline is an update of the previous guidance from
NICE (full guideline published 2004) on depression.

NICE Mental Health Guidelines

These guidelines
from NICE set out clear recommendations, based on the best available evidence,
for health care professionals on how to work with and implement physical,
psychological and service-level interventions for people with various mental
health conditions.

The book contains the full guidelines that cannot be
obtained in print anywhere else. It brings together all of the evidence that led
to the recommendations made, detailed explanations of the methodology behind
their preparation, plus an overview of the condition covering detection,
diagnosis and assessment, and the full range of treatment and care
approaches.

The accompanying free CD-ROM contains all the data used as
evidence, including:

Included and excluded studies.

Profile tables that summarise both the quality of the evidence and the
results of the evidence synthesis.

All meta-analytical data, presented as forest plots.

Detailed information about how to use and interpret forest plots.

Contents:

Contents

1

Preface

1.1

National guideline

1.2

The national depression
guideline

2

Depression

2.1

The disorder

2.2

Aetiology

2.3

Economic costs of
depression

2.4

Treatment and management in the National
Health Service

3

Methods used to develop this
guideline

3.1

Overview

3.2

The scope

3.3

The Guideline Development
Group

3.4

Clinical questions

3.5

Systematic clinical literature
review

3.6

Health economics methods

3.7

Methods for reviewing experience of
care

3.8

Stakeholder contributions

3.9

Validation of the guideline

4

Experience of
care

4.1

Introduction

4.2

Personal accounts - people with
depression

4.3

Personal accounts - carers

4.4

Qualitative analysis

4.5

Review of the qualitative
literature

4.6

From evidence to
recommendations

4.7

Recommendations

5

Case identification and
service delivery

5.1

Introduction

5.2

The identification of depression in
primary care and community settings

5.3

Service delivery systems in the treatment
and management of depression

5.4

Stepped care

5.5

Collaborative care

5.6

Medication management

5.7

Crisis resolution and home treatment
teams

5.8

Acute day hospital care

5.9

Non-acute day hospital care

5.10

Non-statutory support

5.11

Research recommendation

6

Introduction to psychological
and psychosocial interventions

6.1

Introduction

6.2

Recommending psychological and
psychosocial treatments

6.3

How do psychological and psychosocial
interventions become evidence based?

6.4

Contextual factors that impact on
clinical practice

6.5

Databases searched and
inclusion/exclusion criteria

6.6

Studies considered

7

Low-intensity psychosocial
interventions

7.1

Computerised cognitive behavioural
therapy

7.2

Guided self-help

7.3

Physical activity
programmes

7.4

From evidence to recommendations-
low-intensity psychosocial interventions

7.5

Recommendations

8

High-intensity psychological
interventions

8.1

Cognitive and behavioural
therapies

8.2

Behavioural activation

8.3

Problem solving

8.4

Couples therapy

8.5

Interpersonal therapy

8.6

Counselling

8.7

Short-term psychodynamic
psychotherapy

8.8

Rational emotive behavioural
therapy

8.9

Economic modelling

8.10

From evidence to
recommendations

8.11

Recommendations

8.12

Research recommendations

9

Introduction to
pharmacological and physical interventions

9.1

Introduction

9.2

Dose and duration of antidepressant
treatment: evidence from clinical practice

9.3

Limitations of the literature: problems
with randomised controlled trials in pharmacology

9.4

Studies considered for review -
additional inclusion criteria

9.5

Issues and topics covered by this
review

9.6

Placebo-controlled randomised controlled
trials of antidepressants

9.7

Selective serotonin reuptake inhibitors
versus placebo

9.8

Tricyclic antidepressants versus
placebo

9.9

From evidence to
recommendations

9.10

Recommendation

10

Pharmacological
interventions

10.1

Introduction

10.2

Use of individual drugs in the treatment
of depression

10.3

Tricyclic antidepressants

10.4

Selective serotonin reuptake
inhibitors

10.5

Escitalopram

10.6

The THREAD study

10.7

Monoamine oxidase
inhibitors

10.8

Third-generation
antidepressants

10.9

St John's wort

10.10

Health economics evidence

10.11

Network meta-analysis of newer
antidepressants

10.12

Economic model for the cost-effectiveness
of pharmacological interventions for people with depression

10.13

From evidence to
recommendations

10.14

Clinical practice
recommendations

10.15

When to change antidepressant treatment
when symptoms of depression are not improving

11

Factors influencing choice of
antidepressants

11.1

Introduction

11.2

The pharmacological management of
depression in older adults

11.3

The effect of sex on antidepressant
choice

11.4

The pharmacological management of
depression with psychotic symptoms

11.5

The pharmacological management of
atypical depression

11.6

The physical and pharmacological
management of depression with a seasonal pattern

11.7

Dosage issues for tricyclic
antidepressants

11.8

Antidepressant discontinuation
symptoms

11.9

The cardiotoxicity of
antidepressants

11.10

Depression, antidepressants and
suicide

12

The pharmacological and
physical management of depression that has not adequately responded to
treatment, and relapse prevention

12.1

Introduction

12.2

Approach to the reviews

12.3

Pharmacological `next-step' treatment for
depression that has not adequately responded to treatment

12.4

Electroconvulsive therapy

12.5

Other non-pharmacological physical
treatments

12.6

The pharmacological management of relapse
prevention

13

The management of
subthreshold depressive symptoms

13.1

Introduction

13.2

Pharmacological interventions for
subthreshold depressive symptoms and persistent subthreshold depressive symptoms
(dysthymia)

13.3

Psychological and other strategies for
the treatment of persistent subthreshold depressive symptoms
(dysthymia)

13.4

From evidence to
recommendations

13.5

Recommendations

13.6

Research recommendations

14

Summary of
recommendations

14.1

Care of all people with
depression

14.2

Stepped care

14.3

Step 1: recognition, assessment and
initial management

14.4

Step 2: recognised depression -
persistent subthreshold depressive symptoms or mild to moderate
depression

14.5

Step 3: persistent subthreshold
depressive symptoms or mild to moderate depression with inadequate response to
initial interventions, and moderate and severe depression

14.6

Treatment choice based on depression
subtypes and personal characteristics

14.7

Enhanced care for
depression

14.8

Sequencing treatments after initial
inadequate response

14.9

Continuation and relapse
prevention

14.1

Step 4: complex and severe
depression

14.1

Research recommendations

15

Appendices

16

References

17

Abbreviations