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Depression in adults (update)
||NICE 'do not do' recommendation
||When prescribing drugs other than serotonin reuptake inhibitors (SSRIs), dosulepin should not be prescribed.
||Medication management as a separate intervention for people with depression should not be provided routinely by services. It is likely to be effective only when provided as part of a more complex intervention.
||medication management alone|
||Augmentation of an antidepressant with buspirone*, carbamazepine*, lamotrigine* or valproate* [should not be used routinely] as there is insufficient evidence for their use.
||antidepressant augmentation: buspirone*; carbamazepine*; lamotrigine*; valproate*|
||Augmentation of an antidepressant with pindolol* or thyroid hormones* [should not be used routinely] as there is inconsistent evidence of effectiveness
||antidepressant augmentation: pindolol* or thyroid hormones*|
||Current evidence suggests that there are no major safety concerns associated with transcranial magnetic stimulation (TMS) for severe depression. There is uncertainty about the procedure‚??s clinical efficacy, which may depend on higher intensity, greater frequency, bilateral application and/or longer treatment durations than have appeared in the evidence to date. TMS should therefore be performed only in research studies designed to investigate these factors.
||transcranial magnetic stimulation (TMS)|
||Do not use antidepressants routinely to treat persistent subthreshold depressive symptoms or mild depression because the risk benefit ratio is poor, but consider them for people with: A past history of moderate or severe depression or: Initial presentation of subthreshold depressive symptoms that have been present for a long period (typically at least 2 years) or Subthreshold depressive symptoms or mild depression that persist(s) after other interventions.
||Although there is evidence that St John s wort may be of benefit in mild or moderate depression, practitioners should not prescribe or advise its use by people with depression because of uncertainty about appropriate doses, persistence of effect, variation in the nature of preparations and potential serious interactions with other drugs (including oral contraceptives, anticoagulants and anticonvulsants)
||St John‚??s wort|
||Do not switch to, or start, dosulepin because evidence supporting its tolerability relative to other antidepressants is outweighed by the increased cardiac risk and toxicity in overdose.
||Do not use electroconvulsive therapy (ECT) routinely for people with moderate depression but consider it if their depression has not responded to multiple drug treatments and psychological treatment.
||electroconvulsive therapy (ECT)|
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This page was last updated: 12 November 2013