Quality statement 5: Antidepressants for persistent subthreshold depressive symptoms or mild depression

Quality statement 5: Antidepressants for persistent subthreshold depressive symptoms or mild depression

Quality statement

People with persistent subthreshold depressive symptoms or mild depression are prescribed antidepressants only when they meet specific clinical criteria in accordance with NICE guidance.

Quality measure

Structure: Evidence of local arrangements to support the correct prescribing of antidepressants to people with persistent subthreshold depressive symptoms or mild depression in accordance with the NICE guidance.

Process: Proportion of people with persistent subthreshold depressive symptoms or mild depression prescribed antidepressant medication who meet specific clinical criteria for the prescription of antidepressants in accordance with NICE guidance.

Numerator – the number of people in the denominator meeting the specific clinical criteria for the prescription of antidepressants in accordance with NICE guidance.

Denominator – the number of people with persistent subthreshold depressive symptoms or mild depression prescribed antidepressants.

What the quality statement means for each audience

Service providers ensure policies are in place for the prescription of antidepressants to people with subthreshold depressive symptoms or mild depression only when specific clinical criteria are met in accordance with NICE guidance.

Healthcare professionals ensure they prescribe antidepressants to people with subthreshold depressive symptoms or mild depression only when the person meets the specific clinical criteria in accordance with NICE guidance.

Commissioners ensure they commission services that monitor whether the prescription of antidepressants to people with subthreshold depressive symptoms or mild depression is being carried out in accordance with NICE guidance.

People with some mild but long-lasting symptoms of depression or mild depression are not usually prescribed antidepressants except in particular circumstances (for example, if they have had moderate or severe depression in the past; have depression which has lasted for a long time – usually at least 2 years; still have depression after other treatments; or if treatment of a physical health problem is made more difficult because of mild depression).

Definitions

The term 'people with persistent subthreshold depressive symptoms or mild depression' includes all people with persistent subthreshold depressive symptoms or mild depression and a chronic physical health problem.

NICE clinical guideline 90 recommendation 1.4.4.1 and NICE clinical guideline 91 recommendation 1.4.3.1 state that antidepressants should not be used routinely for people with persistent subthreshold depressive symptoms or mild depression, but may be considered in cases where there is:

  • 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 or

  • mild depression that complicates the care of a physical health problem (for people with depression and a chronic physical health problem only).

Source guidance

NICE clinical guideline 90 recommendation 1.4.4.1 and NICE clinical guideline 91 recommendation 1.4.3.1 (key priorities for implementation).

Data source

Structure: Local data collection.

Process: Local data collection.