NICE guidelines for the management of depression

doi:10.1136/bmj.330.7486.267

BMJ 2005;330:267-268 (5 February), doi:10.1136/bmj.330.7486.267

Editorial

NICE guidelines for the management of depression

Are clear for severe depression, but uncertain for mild or moderatedepression

The first 150 words of the full text of this article appear below.

Guidelines from the National Institute for Clinical Excellence(NICE) focus on clinical conditions that have a substantialimpact on public health and aim to improve standards of careand reduce variations in provision. Depression is a common condition,contributing 12% of the total burden of nonfatal global disease.¹Variations in its treatment within the NHS are striking andperplexing.^2
3 We welcome these guidelines and recent advicefrom the Medicines and Healthcare products Regulatory Agency(MHRA) concerning the prescription of antidepressants.^4
5

The methods underpinning the guidelines were rigorous and produceda definitive summary of current evidence. However, the uncertaintyof many recommendations is disappointing. The guidelines advocatea stepped care approach, but the weakness of evidence supportingstructured interventions for mild to moderate depression limitsthe value of recommendations referring to initial steps.

The review of the evidence highlights associations between theseverity of depression and response to antidepressant medication.. . . [Full text of this article]

Hugh Middleton, senior lecturer

Division of Psychiatry, University of Nottingham, Nottingham NG3 6AA

Ian Shaw, professor of health policy, Sally Hull, clinical senior lecturer

School of Sociology and Social Policy, University of Nottingham, Nottingham NG7 2RD

Gene Feder, professor of primary care research and development

Barts and the London, Queen Mary's School of Medicine and Dentistry, London E14NS (g.s.feder@qmul.ac.uk)

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