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Depression guidelines

Management of depression in primary and secondary care

National Collaborating Centre for Mental Health

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Format: A4 paperback, 362pp
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An unsupported version of this publication can be downloaded for free.

A short version of this guideline and a quick reference guide are available free of charge from the National Institute for Health and Clinical Excellence (NICE), together with information for the public, from:

NICE guideline http://guidance.nice.org.uk/CG23/niceguidance/pdf/English
Quick ref guide
http://guidance.nice.org.uk/CG23/quickrefguide/pdf/English
Information for the public http://guidance.nice.org.uk/CG23/publicinfo/pdf/English

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Please note: Amendments to recommendations concerning venlafaxine

On 31 May 2006 the MHRA issued revised prescribing advice for venlafaxine*. NICE has made amendments to the NICE guideline, the Quick Reference Guide and the Information for the Public to bring them into line with the new advice but has not made changes to other areas where new evidence may be available. NICE expects to make a decision on a full update later in 2007.

The amended guidance is available at: http://guidance.nice.org.uk/CG23

The full guideline itself has not been amended.

*see:
http://www.mhra.gov.uk/home/idcplg?IdcService=SS_GET_PAGE&useSecondary=true&ssDocName=CON2023843&ssTargetNodeld+389

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Information about the guidelines

This evidence-based clinical guideline endorsed by NICE presents guidance on physical, psychological and service-level interventions for depression.

In this volume, we present the full guideline, including the evidence on which the guideline statements are based, and a detailed explanation of the methodology behind the guideline’s preparation. An essential resource for all professionals involved in the management of depression, this book is a milestone in the development of truly independent and transparent clinical guidance and an essential tool in improving the quality of mental healthcare in the UK.

• Full details of studies included in the guideline and reasons for excluding studies, with reference list
• A full list of guideline statements
• All meta-analytical data, presented as forest plots
• Detailed information about how to use and interpret forest plots.

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Contents

Depression Guideline Development Group Members. National Collaborating Centre for Mental Health staff.

1 Introduction

National guidelines. The national depression guideline

2 Depression

The disorder. Incidence and prevalence. Diagnosis. Aetiology. Use of health service resources and other costs. Treatment and management in the NHS. The experience of depression. Patient preference, information, consent and mutual support.

3 Methods used to develop this guideline

Overview. The Guideline Development Group. Clinical questions. Systematic clinical literature review. Evidence on safety and harm. Health economics review strategies. Stakeholder contributions. Validation of this guideline.

4 Summary of recommendations

Good practice points relevant to the care of all people with depression. Stepped care. Step 1: Recognition of depression in primary care and general hospital settings. Step 2: Recognised depression in primary care - mild depression. Step 3: Recognised depression in primary care - moderate or severe. Step 4: Specialist mental health services - treatment-resistant, recurrent, atypical and psychotic depression. Step 5: Depression needing inpatient care. Research recommendations.

5 Service-level and other interventions in the treatment
and management of depression

Introduction. Screening. Guided self-help. Computerised cognitive behavioural therapy. Exercise. Organisational developments in the treatment of depression. Non-statutory support. Crisis resolution and home treatment teams. Day hospitals. Electroconvulsive therapy.

6 Review of psychological therapies for depression

Introduction. Cognitive behavioural therapies (CBT). Behaviour therapy (BT). Interpersonal psychotherapy (IPT). Problem-solving therapy. Counselling. Short-term psychodynamic psychotherapy. Couple-focused therapies. Psychological interventions in older adults. Short-term psychological treatments. Clinical practice recommendations for psychological interventions. Research recommendations for psychological interventions.

7 Introduction to pharmacological interventions in the treatment and
management of depression

Introduction. Dose and duration of antidepressant treatment: Evidence from clinical practice. Limitations of the literature: Problems with randomised controlled trials (RCTs) in pharmacology. The placebo response. Studies considered for review - additional inclusion criteria. Issues and topics covered by this review. Review of SSRIs versus placebo.

8 Pharmacological interventions in the treatment and management of depression

Use of individual drugs in the treatment of depression. Factors that influence choice of antidepressant. The pharmacological treatment of treatment-resistant depression.

9 Health economics evidence

Background. Key economic issues. Systematic literature review. Cost-effectiveness modelling. Research recommendations.

Appendices. References. Abbreviations. Glossary of terms.

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