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Practice Guidelines

Management of depression in adults: summary of updated NICE guidance

BMJ 2022; 378 doi: https://doi.org/10.1136/bmj.o1557 (Published 20 July 2022) Cite this as: BMJ 2022;378:o1557
  1. Tony Kendrick, general practitioner and professor of primary care1,
  2. Steve Pilling, professor of clinical psychology and clinical effectiveness, clinical adviser23,
  3. Ifigeneia Mavranezouli, senior health economist,2 3,
  4. Odette Megnin-Viggars, senior systematic reviewer2 3,
  5. Catherine Ruane, carer member of Guideline Committee,
  6. Hilary Eadon, guideline lead4,
  7. Navneet Kapur, professor of psychiatry and population health, honorary consultant in psychiatry56
  8. on behalf of the Guideline Committee
  1. 1University of Southampton, Southampton, UK
  2. 2University College London, London, UK
  3. 3National Guideline Alliance, Royal College of Obstetricians and Gynaecologists, London, UK
  4. 4National Institute for Health and Care Excellence, London, UK
  5. 5University of Manchester, Manchester, UK
  6. 6Greater Manchester Mental Health and Social Care Trust, Manchester, UK
  1. Correspondence to T Kendrick A.R.Kendrick{at}Southampton.ac.uk

What you need to know

  • Discuss treatment options to match the needs and preferences of a person with a new episode of depression

  • Consider the least intrusive and least resource-intensive available treatment (eg, guided self-help) first for less severe depression

  • Do not offer antidepressant medication routinely as first line treatment for less severe depression unless that is the person’s preference

  • When stopping antidepressants, advise a relatively long tapering using a proportional (hyperbolic) reduction schedule

Since the National Institute for Health and Care Excellence (NICE) published its last guideline on depression in 2009,1 the prevalence of depression has increased,2 particularly among vulnerable adults during the covid-19 pandemic.3 Yet fewer than half of people affected receive treatment,2 despite increased provision of psychological therapies4 and antidepressants.5 Most people who are treated still receive antidepressants6 despite previous guideline recommendations to offer psychological therapies first,1 and Public Health England is concerned that long term antidepressant prescribing is increasing, with many people experiencing withdrawal symptoms and having difficulty stopping them when appropriate.7 In addition to cognitive behavioural therapy (CBT) as previously recommended,1 other psychological treatments that have shown promise in recent years include behavioural activation8 and mindfulness based therapies,9 and these could offer more alternatives to antidepressants in the future.

This article summarises new recommendations on management of depression most relevant to primary care and services providing psychological therapies, from the NICE guideline published in June 2022,10 updating and replacing the 2009 guideline.1

NICE recommendations are based on systematic reviews of best available evidence and explicit consideration of cost effectiveness. When minimal evidence is available, recommendations are based on the Guideline Committee (GC)’s experience and opinion of what constitutes good practice. Evidence levels for the recommendations are given in italics in square brackets. Definitions of evidence certainty …

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