Update information

Update information

April 2018: Footnotes in the guideline have been amended to link to the MHRA's latest advice and resources on sodium valproate. Medicines containing valproate taken in pregnancy can cause malformations in 11% of babies and developmental disorders in 30–40% of children after birth. Valproate treatment must not be used in girls and women including in young girls below the age of puberty, unless alternative treatments are not suitable and unless the terms of the pregnancy prevention programme are met. This programme includes: assessment of patients for the potential of becoming pregnant; pregnancy tests; counselling patients about the risks of valproate treatment; explaining the need for effective contraception throughout treatment; regular (at least annual) reviews of treatment by a specialist, and completion of a risk acknowledgement form. In pregnancy, valproate is contraindicated and an alternative treatment should be decided on, with appropriate specialist consultation. See the MHRA toolkit to ensure female patients are better informed about the risks of taking valproate during pregnancy.

April 2016: Recommendation has been deleted and replaced with a link to the NICE interventional procedures guidance on repetitive transcranial magnetic stimulation for depression.

Minor changes since publication

September 2019: Recommendation 1.9.21 on stopping antidepressants has been replaced and a new recommendation 1.9.22 added, and subsequent recommendations renumbered. This is to bring the advice in this section in line with current practice.

About this guideline

The following recommendations have been taken from the previous NICE clinical guideline 23 'Management of depression in primary and secondary care'. Note that the evidence for these recommendations has not been updated. Any wording changes have been made for clarification only.

Recommendation number in updated NICE clinical guideline 90

Recommendation number in NICE clinical guideline 23

Recommendations marked [2018] have had a footnote on sodium valproate amended during the April 2018 update. Recommendations marked [2019] were amended in September 2019 (see Update information).

  • National Institute for Health and Care Excellence (NICE)