Revised NICE Guideline on Depression in Adults

29 June 2022

“CBT remains the treatment of choice for adults with depression”

The British Association for Behavioural and Cognitive Psychotherapies, the lead organisation for CBT in the UK and Ireland, welcome revisions to the NICE guidelines on depression in adults (released 29^th June 2022). BABCP very strongly welcome the recommendation that cognitive and behavioural therapies are the treatment of choice for less severe and more severe depression.

BABCP President Dr Andrew Beck said

“These guidelines offer a real opportunity for NHS mental health services to listen to what patients need and want, and to collaborate with them to decide what treatment and care they need. The guidelines also highlight the amazing value of psychological well-being practitioners at the front line of mental health services, working alongside specialist CBT therapists, and other staff in multidisciplinary teams

Guided self-help with Psychological Wellbeing Practitioners is the treatment of choice for adults with less severe depression.

The NICE guidelines recognise the importance of the offering people the least intrusive treatment first, with the option to try more intensive treatment if needed. Depression is a common mental health problem, that affects at least 3 in a hundred people at any one time, with serious and sometimes fatal consequences. Offering evidence-based treatment quickly is critical, will help more people recover, and makes best use of NHS resources.

NICE considered detailed feedback from BABCP members. In response, they adapted the guidance in several crucial ways. In particular, the voices of Psychological Wellbeing Practitioners (PWPs) were listened to and the value of their role is recognised and even strengthened in this guidance. 

Cognitive and behavioural therapies are also the treatments of choice for more severe depression, in combination with anti-depressant medication if this is acceptable to the individual patient.

The guidelines also recognise that patient’s preferences about individual or group therapy, and medication are central in making decisions about treatment. 

Other important changes following our feedback, include:

• The age of 'young people’ being clearly specified (18-25 years) to avoid confusion with adolescents under 18 (who have their own separate guidelines).
• Highlighting that Mindfulness Based Cognitive Therapy is an effective and cost-effective treatment for depression
• Making sure that all patients are helped to avoid future episodes of depression
• Recommending 16 session of individual CBT for severe depression and extra sessions for relapse prevention for patients who have a high risk of relapse.

BABCP have concerns about some areas of the guidance

• Behavioural Couples Therapy has been marginalised in the current guidelines despite a promising evidence base for this intervention and trained and qualified practitioners working in NHS services.
• Guided self-help and group exercise are recommended for adults with severe depression – this means that patients who are at risk of self-harm or suicide may not be adequately monitored.
• Some therapies recommended by NICE are not currently available in NHS mental health services e.g. problem solving therapy and group exercise.

We look forward to reading and commenting on the Implementation Guide which NICE will be publishing in due course, and further reviews of the evidence for treatment for this important patient group.

For further comment please contact media@babcp.com