People suffering depression should be offered therapy before drugs, NHS guidance says

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People with mild depression should be offered therapy or exercise before being prescribed antidepressants, says new NHS guidance.

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The National Institute for Health and Care Excellence (Nice) said people should have the opportunity to participate in activities such as meditation or behavioral therapy, or individual counseling sessions before being provided with medication.

The draft guideline, which is subject to counseling, states: “Do not routinely offer antidepressant medication as a first-line treatment for less severe depression, unless that is the individual’s preference.”


It asks doctors to engage patients in conversations about what would be best for them, but says group cognitive behavioral therapy (CBT) can be offered as a primary treatment.

CBT focuses on how thoughts, beliefs, attitudes, feelings and behaviors interact, setting goals and teaching better coping skills.

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Other interventions suggested by Nice include group behavior activation (BA), which helps a person recognize negative patterns and focus on behaviors associated with improved mood.

Individual BA or CBT may also be offered, along with group mindfulness or meditation, group exercises, and counseling.

Nice said people can be offered a menu of treatments to choose from as part of a discussion about what may be contributing to their depression, and the person’s experience of any prior episodes of depression or treatment. .

It said the new draft guideline for the identification, treatment and management of depression in adults is the first in 12 years.

A similar range of psychological interventions, with the option of antidepressant medication, are available for those choosing first-line treatment for more severe depression.

Dr Paul Crisp, director of the Center for Guidelines in Nice, said: “People with depression deserve and expect the best treatment from the NHS, which is why this guideline is urgently needed.

“The COVID-19 pandemic has shown us the impact it has on the mental health of the country.

“People with depression need these evidence-based guideline recommendations available to the NHS without delay.”

The guidance also tells doctors to discuss mental health waiting lists with patients and how long they may have to wait for treatment.

Nav Kapur, Professor of Psychiatry and Population Health at the University of Manchester and Chair of the Guidelines Committee, said: “As a committee we have prepared recommendations that we hope will have a real impact on people living with depression and their caregivers.

“In particular we have emphasized the role of patient choice – suggesting that clinicians should provide people with a choice of evidence-based treatments and understand that not every treatment will be tailored to every individual.”

The guideline also says that medics should discuss what happens if people want to stop taking antidepressants, which can take weeks or months to return.

Figures from the NHS Business Services Authority show that more than 20 million antidepressants were prescribed between October and December 2020. The use of antidepressants has been increasing steadily since 2015.

PA. Additional reporting by


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