Contents
1
Preface
1.1
National guideline
1.2
The national depression guideline
2
Depression
2.1
The disorder
2.2
Aetiology
2.3
Economic costs of depression
2.4
Treatment and management in the National Health Service
3
Methods used to develop this guideline
3.1
Overview
3.2
The scope
3.3
The Guideline Development Group
3.4
Clinical questions
3.5
Systematic clinical literature review
3.6
Health economics methods
3.7
Methods for reviewing experience of care
3.8
Stakeholder contributions
3.9
Validation of the guideline
4
Experience of care
4.1
Introduction
4.2
Personal accounts - people with depression
4.3
Personal accounts - carers
4.4
Qualitative analysis
4.5
Review of the qualitative literature
4.6
From evidence to recommendations
4.7
Recommendations
5
Case identification and service delivery
5.1
Introduction
5.2
The identification of depression in primary care and community settings
5.3
Service delivery systems in the treatment and management of depression
5.4
Stepped care
5.5
Collaborative care
5.6
Medication management
5.7
Crisis resolution and home treatment teams
5.8
Acute day hospital care
5.9
Non-acute day hospital care
5.10
Non-statutory support
5.11
Research recommendation
6
Introduction to psychological and psychosocial interventions
6.1
Introduction
6.2
Recommending psychological and psychosocial treatments
6.3
How do psychological and psychosocial interventions become evidence based?
6.4
Contextual factors that impact on clinical practice
6.5
Databases searched and inclusion/exclusion criteria
6.6
Studies considered
7
Low-intensity psychosocial interventions
7.1
Computerised cognitive behavioural therapy
7.2
Guided self-help
7.3
Physical activity programmes
7.4
From evidence to recommendations- low-intensity psychosocial interventions
7.5
Recommendations
8
High-intensity psychological interventions
8.1
Cognitive and behavioural therapies
8.2
Behavioural activation
8.3
Problem solving
8.4
Couples therapy
8.5
Interpersonal therapy
8.6
Counselling
8.7
Short-term psychodynamic psychotherapy
8.8
Rational emotive behavioural therapy
8.9
Economic modelling
8.10
From evidence to recommendations
8.11
Recommendations
8.12
Research recommendations
9
Introduction to pharmacological and physical interventions
9.1
Introduction
9.2
Dose and duration of antidepressant treatment: evidence from clinical practice
9.3
Limitations of the literature: problems with randomised controlled trials in pharmacology
9.4
Studies considered for review - additional inclusion criteria
9.5
Issues and topics covered by this review
9.6
Placebo-controlled randomised controlled trials of antidepressants
9.7
Selective serotonin reuptake inhibitors versus placebo
9.8
Tricyclic antidepressants versus placebo
9.9
From evidence to recommendations
9.10
Recommendation
10
Pharmacological interventions
10.1
Introduction
10.2
Use of individual drugs in the treatment of depression
10.3
Tricyclic antidepressants
10.4
Selective serotonin reuptake inhibitors
10.5
Escitalopram
10.6
The THREAD study
10.7
Monoamine oxidase inhibitors
10.8
Third-generation antidepressants
10.9
St John's wort
10.10
Health economics evidence
10.11
Network meta-analysis of newer antidepressants
10.12
Economic model for the cost-effectiveness of pharmacological interventions for people with depression
10.13
From evidence to recommendations
10.14
Clinical practice recommendations
10.15
When to change antidepressant treatment when symptoms of depression are not improving
11
Factors influencing choice of antidepressants
11.1
Introduction
11.2
The pharmacological management of depression in older adults
11.3
The effect of sex on antidepressant choice
11.4
The pharmacological management of depression with psychotic symptoms
11.5
The pharmacological management of atypical depression
11.6
The physical and pharmacological management of depression with a seasonal pattern
11.7
Dosage issues for tricyclic antidepressants
11.8
Antidepressant discontinuation symptoms
11.9
The cardiotoxicity of antidepressants
11.10
Depression, antidepressants and suicide
12
The pharmacological and physical management of depression that has not adequately responded to treatment, and relapse prevention
12.1
Introduction
12.2
Approach to the reviews
12.3
Pharmacological `next-step' treatment for depression that has not adequately responded to treatment
12.4
Electroconvulsive therapy
12.5
Other non-pharmacological physical treatments
12.6
The pharmacological management of relapse prevention
13
The management of subthreshold depressive symptoms
13.1
Introduction
13.2
Pharmacological interventions for subthreshold depressive symptoms and persistent subthreshold depressive symptoms (dysthymia)
13.3
Psychological and other strategies for the treatment of persistent subthreshold depressive symptoms (dysthymia)
13.4
From evidence to recommendations
13.5
Recommendations
13.6
Research recommendations
14
Summary of recommendations
14.1
Care of all people with depression
14.2
Stepped care
14.3
Step 1: recognition, assessment and initial management
14.4
Step 2: recognised depression - persistent subthreshold depressive symptoms or mild to moderate depression
14.5
Step 3: persistent subthreshold depressive symptoms or mild to moderate depression with inadequate response to initial interventions, and moderate and severe depression
14.6
Treatment choice based on depression subtypes and personal characteristics
14.7
Enhanced care for depression
14.8
Sequencing treatments after initial inadequate response
14.9
Continuation and relapse prevention
14.1
Step 4: complex and severe depression
14.1
Research recommendations
15
Appendices
16
References
17
Abbreviations
