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1
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Preface
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1.1
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National guideline
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1.2
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The national depression guideline
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2
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Depression
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2.1
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The disorder
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2.2
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Aetiology
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2.3
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Economic costs of depression
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2.4
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Treatment and management in the National
Health Service
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3
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Methods used to develop this
guideline
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3.1
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Overview
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3.2
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The scope
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3.3
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The Guideline Development Group
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3.4
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Clinical questions
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3.5
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Systematic clinical literature review
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3.6
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Health economics methods
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3.7
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Methods for reviewing experience of care
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3.8
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Stakeholder contributions
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3.9
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Validation of the guideline
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4
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Experience of care
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4.1
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Introduction
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4.2
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Personal accounts – people with depression
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4.3
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Personal accounts – carers
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4.4
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Qualitative analysis
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4.5
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Review of the qualitative literature
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4.6
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From evidence to recommendations
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4.7
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Recommendations
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5
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Case identification and service
delivery
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5.1
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Introduction
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5.2
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The identification of depression in primary
care and community settings
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5.3
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Service delivery systems in the treatment and
management of depression
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5.4
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Stepped care
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5.5
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Collaborative care
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5.6
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Medication management
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5.7
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Crisis resolution and home treatment teams
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5.8
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Acute day hospital care
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5.9
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Non-acute day hospital care
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5.10
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Non-statutory support
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5.11
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Research recommendation
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6
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Introduction to psychological and
psychosocial interventions
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6.1
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Introduction
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6.2
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Recommending psychological and psychosocial
treatments
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6.3
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How do psychological and psychosocial
interventions become evidence based?
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6.4
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Contextual factors that impact on clinical
practice
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6.5
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Databases searched and inclusion/exclusion
criteria
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6.6
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Studies considered
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7
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Low-intensity psychosocial
interventions
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7.1
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Computerised cognitive behavioural therapy
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7.2
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Guided self-help
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7.3
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Physical activity programmes
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7.4
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From evidence to recommendations-
low-intensity psychosocial interventions
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7.5
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Recommendations
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8
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High-intensity psychological
interventions
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8.1
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Cognitive and behavioural therapies
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8.2
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Behavioural activation
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8.3
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Problem solving
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8.4
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Couples therapy
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8.5
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Interpersonal therapy
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8.6
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Counselling
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8.7
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Short-term psychodynamic psychotherapy
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8.8
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Rational emotive behavioural therapy
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8.9
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Economic modelling
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8.10
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From evidence to recommendations
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8.11
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Recommendations
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8.12
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Research recommendations
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9
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Introduction to pharmacological and
physical interventions
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9.1
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Introduction
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9.2
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Dose and duration of antidepressant treatment:
evidence from clinical practice
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9.3
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Limitations of the literature: problems with
randomised controlled trials in pharmacology
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9.4
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Studies considered for review – additional
inclusion criteria
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9.5
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Issues and topics covered by this review
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9.6
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Placebo-controlled randomised controlled
trials of antidepressants
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9.7
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Selective serotonin reuptake inhibitors versus
placebo
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9.8
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Tricyclic antidepressants versus placebo
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9.9
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From evidence to recommendations
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9.10
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Recommendation
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10
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Pharmacological
interventions
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10.1
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Introduction
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10.2
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Use of individual drugs in the treatment of
depression
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10.3
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Tricyclic antidepressants
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10.4
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Selective serotonin reuptake inhibitors
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10.5
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Escitalopram
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10.6
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The THREAD study
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10.7
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Monoamine oxidase inhibitors
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10.8
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Third-generation antidepressants
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10.9
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St John’s wort
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10.10
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Health economics evidence
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10.11
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Network meta-analysis of newer
antidepressants
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10.12
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Economic model for the cost-effectiveness of
pharmacological interventions for people with depression
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10.13
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From evidence to recommendations
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10.14
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Clinical practice recommendations
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10.15
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When to change antidepressant treatment when
symptoms of depression are not improving
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11
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Factors influencing choice of
antidepressants
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11.1
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Introduction
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11.2
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The pharmacological management of depression
in older adults
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11.3
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The effect of sex on antidepressant choice
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11.4
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The pharmacological management of depression
with psychotic symptoms
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11.5
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The pharmacological management of atypical
depression
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11.6
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The physical and pharmacological management of
depression with a seasonal pattern
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11.7
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Dosage issues for tricyclic
antidepressants
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11.8
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Antidepressant discontinuation symptoms
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11.9
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The cardiotoxicity of antidepressants
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11.10
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Depression, antidepressants and suicide
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12
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The pharmacological and physical
management of depression that has not adequately responded to
treatment, and relapse prevention
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12.1
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Introduction
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12.2
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Approach to the reviews
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12.3
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Pharmacological ‘next-step’ treatment for
depression that has not adequately responded to treatment
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12.4
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Electroconvulsive therapy
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12.5
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Other non-pharmacological physical
treatments
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12.6
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The pharmacological management of relapse
prevention
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13
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The management of subthreshold
depressive symptoms
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13.1
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Introduction
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13.2
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Pharmacological interventions for subthreshold
depressive symptoms and persistent subthreshold depressive symptoms
(dysthymia)
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13.3
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Psychological and other strategies for the
treatment of persistent subthreshold depressive symptoms
(dysthymia)
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13.4
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From evidence to recommendations
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13.5
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Recommendations
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13.6
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Research recommendations
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14
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Summary of
recommendations
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14.1
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Care of all people with depression
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14.2
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Stepped care
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14.3
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Step 1: recognition, assessment and initial
management
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14.4
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Step 2: recognised depression - persistent
subthreshold depressive symptoms or mild to moderate depression
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14.5
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Step 3: persistent subthreshold depressive
symptoms or mild to moderate depression with inadequate response to
initial interventions, and moderate and severe depression
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14.6
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Treatment choice based on depression subtypes
and personal characteristics
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14.7
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Enhanced care for depression
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14.8
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Sequencing treatments after initial inadequate
response
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14.9
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Continuation and relapse prevention
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14.1
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Step 4: complex and severe depression
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14.1
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Research recommendations
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15
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Appendices
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16
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References
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17
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Abbreviations
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