This guideline covers identifying and managing depression in adults aged 18 years and older, in primary and secondary care. It aims to improve care for people with depression by promoting improved recognition and treatment.
MHRA advice on antiepileptic drugs in pregnancy: In January 2021, the Medicines and Healthcare products Regulatory Agency (MHRA) updated safety advice on antiepileptic drugs in pregnancy. We are reviewing the recommendations on carbamazepine and lamotrigine in this guideline, and will amend them as needed. In the meantime, take account of MHRA advice when discussing treatment with women and girls of childbearing potential.
MHRA advice on valproate: We have amended a recommendation in the section on combining and augmenting medications in line with the MHRA guidance on valproate use by women and girls. Valproate must not be used in women and girls of childbearing potential (including young girls who are likely to need treatment into their childbearing years), unless other options are unsuitable and the pregnancy prevention programme is in place. The MHRA has published temporary advice on the valproate pregnancy prevention programme during the COVID-19 pandemic.
NICE has also produced a guideline on depression in adults with a chronic physical health problem.
This guideline includes recommendations on:
- care of all people with depression
- stepped care
- treatment choice based on depression subtypes and personal characteristics
- enhanced care for depression
- sequencing treatments after initial inadequate response
- continuation and relapse prevention
- complex and severe depression
Who is it for?
- Healthcare professionals
- People with depression, their families and carers
Is this guideline up to date?
Guideline development process
This guideline updates and replaces NICE guideline CG23 (December 2004).
The recommendations in this guideline represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, professionals and practitioners are expected to take this guideline fully into account, alongside the individual needs, preferences and values of their patients or the people using their service. It is not mandatory to apply the recommendations, and the guideline does not override the responsibility to make decisions appropriate to the circumstances of the individual, in consultation with them and their families and carers or guardian.
All problems (adverse events) related to a medicine or medical device used for treatment or in a procedure should be reported to the Medicines and Healthcare products Regulatory Agency using the Yellow Card Scheme.
Local commissioners and providers of healthcare have a responsibility to enable the guideline to be applied when individual professionals and people using services wish to use it. They should do so in the context of local and national priorities for funding and developing services, and in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities. Nothing in this guideline should be interpreted in a way that would be inconsistent with complying with those duties.
Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.