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The Royal College of Psychiatrists Improving the lives of people with mental illness

Depression: The NICE Guideline on the Treatment and Management of Depression in Adults (Updated edition)

National Collaborating Centre for Mental Health (NCCMH)


Price: £35.00

College members' price: £31.50

Published: Aug 2010

Format: Paperback + free CD-ROM

Number of pages: 704

ISBN: 9781904671855

Depression: The NICE Guideline on the Treatment and Management of Depression in Adults (Updated edition)

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.

 

Also see the 'sister' NICE guideline: Depression in Adults with a Chronic Physical Health Problem: The NICE Guideline on Treatment and Management

List of the other NICE mental health guidelines


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

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

   

 

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