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 moderate depression

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 substantial impact on public health and aim to improve standards of care and reduce variations in provision. Depression is a common condition, contributing 12% of the total burden of nonfatal global disease.¹ Variations in its treatment within the NHS are striking and perplexing.^{2 3} We welcome these guidelines and recent advice from the Medicines and Healthcare products Regulatory Agency (MHRA) concerning the prescription of antidepressants.^{4 5}

The methods underpinning the guidelines were rigorous and produced a definitive summary of current evidence. However, the uncertainty of many recommendations is disappointing. The guidelines advocate a stepped care approach, but the weakness of evidence supporting structured interventions for mild to moderate depression limits the value of recommendations referring to initial steps.

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

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

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

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

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• Siriwardena, A N. (2008). Review: non-psychiatric physicians have low accuracy for recognising depression in their patients. Evid. Based Med. 13: 85-85 [Full text]  
• Pollock, K. (2007). Maintaining face in the presentation of depression: constraining the therapeutic potential of the consultation. Health (London) 11: 163-180 [Abstract]  
• Cipriani, A. (2005). Forensic database study suggests selective serotonin reuptake inhibitors do not increase the risk of suicide in people taking antidepressants. Evid. Based Ment. Health 8: 113-113 [Full text]  
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Deficient NICE guidelines on depression

Ellen C G Grant
bmj.com, 6 Feb 2005 [Full text]

An alternative view on why NICE guidelines for mild-moderate depression are unclear.

Jackie T Gordon
bmj.com, 7 Feb 2005 [Full text]

Lack of clinical significance of antidepressants

D B Double
bmj.com, 8 Feb 2005 [Full text]

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