Suicide Risk

Depression: NICE guidelines on management

NICE updated its depression guidelines in 2022. It now favours a simple classification of depression severity

• 'less severe' depression: encompasses what was previously termed subthreshold and mild depression
  • a PHQ-9 score of < 16
• 'more severe' depression: encompasses what was previously termed moderate and severe depression
  • a PHQ-9 score of ≥ 16

The NICE guidelines are long and contain many important principles about dealing with patients who have depression. The following is a very brief section highlighting key points.

Management of less severe depression

NICE lists a large number of interventions that may be used first-line. It encourages us to discuss treatment options with patients to reach a shared decision. They recommend considering 'the least intrusive and least resource intensive treatment first'. It also recommends not routinely offering 'antidepressant medication as first-line treatment for less severe depression, unless that is the person's preference'.

Treatment options (considered as psychological interventions rather than lifestyle and diet advise), listed in order of preference by NICE

• guided self-help
• group cognitive behavioural therapy (CBT)
• group behavioural activation (BA)
• individual CBT
• individual BA
• group exercise
• group mindfulness and meditation
• interpersonal psychotherapy (IPT)
• selective serotonin reuptake inhibitors (SSRIs)
• counselling
• short-term psychodynamic psychotherapy (STPP)