NHS to offer treatment for depression before medication is taken under new guidelines | Depression
Millions of people with mild depression in England are expected to be offered therapy, exercise, mindfulness or meditation ahead of antidepressants, according to the first new NHS guidelines in more than a decade.
As part of the draft guidelines, the National Institute for Health and Excellence in Care (Nice) recommends that the âmenu of treatment optionsâ be offered to patients by healthcare professionals before medication is released. considered.
Currently, people with mild depression are offered antidepressants or a high-intensity psychological intervention, such as cognitive behavioral therapy (CBT). The redesign is among the first new recommendations to identify, treat and manage depression in adults since 2009.
According to the Office for National Statistics (ONS), about one in six adults (17%) suffered from some form of depression this summer. The rate is higher than before the pandemic, when 10% of adults experienced it. Young adults and women are more likely to be affected, the ONS found.
A 2019 review showed that 17% of the adult population in England (7.3 million people) had been prescribed antidepressants in the year 2017-18.
Dr Paul Chrisp, director of the Nice Guidance Center, said: âThe Covid-19 pandemic has shown us the impact of depression on the mental health of the country. People with depression need these evidence-based recommendations available to the NHS, without delay. “
As part of the changes, people with ‘less severe depression’, which includes people with mild depression, should be involved in conversations with doctors about what would work best for them, but cognitive behavioral therapy (CBT ) group could be offered as the first treatment. CBT “focuses on how thoughts, beliefs, attitudes, feelings and behavior interact, and teaches coping skills to deal with things in life differently.”
This could be followed by offers of seven other treatments, including individual CBT, self-help, group exercise, or group mindfulness or meditation, before medication is discussed as an option.
Group exercises will typically involve three 60-minute sessions per week for 10 weeks, Nice said. Alternatively, patients can opt for mindfulness or group meditation, which Nice says typically consist of eight weekly two-hour sessions and focus on “focusing on the present, observing, and sitting with thoughts, feelings and bodily sensations, and breathing exercises â.
The directive goes on to say, âDo not routinely offer antidepressants as the first-line treatment for less severe depression, unless it is the person’s preference. “
A similar range of psychological interventions, as well as the option of antidepressant medication, should be available for those choosing first-line treatment for “more severe depression.”
When considering treatment options, Nice said people should also be encouraged to discuss what may be contributing to their depression and the patient’s experience with any previous bouts of depression or treatments.
Nav Kapur, Professor of Psychiatry and Population Health at the University of Manchester and Chairman of the Guidelines Committee, said: âAs a committee we have come up with recommendations which we hope will have a real impact on people with depression and their caregivers. . In particular, we emphasized the role of patient choice – suggesting that practitioners should offer people an evidence-based treatment choice and understand that not all treatments will be right for everyone.
The guidelines recommend that physicians discuss mental health wait lists with patients. It also contains new recommendations for those who stop antidepressants.
People who are considering taking or stopping antidepressant medications should discuss the benefits and risks with their healthcare professional, Nice said. Doctors should explain that withdrawal can take weeks or months to complete successfully, that it is usually necessary to reduce the dose in stages over time, and that most people successfully stop antidepressants.
Figures from the NHS Business Services Authority show more than 20 million antidepressants were prescribed between October and December 2020, a 6% increase from the same three months in 2019.
“There have been significant advances in science and medicine over the past 12 years,” said retired lawyer Catherine Ruane, a lay member of the guidelines committee who acted as a caregiver to two members. of family suffering from depression. “This guideline emphasizes more choice for patients and takes more account of the things that really matter to patients and their caregivers.”