NICE amends guidelines on treatment of depression

NICE has recently drafted amendments to their guidelines on treatment of depression expected to be published in May 2022. They advise that patients with less severe depression be recommended CBT, counselling or exercise before being prescribed medication [1]. This has reignited conversations around what options are best for doctors to recommend as a first line of treatment for depression.



One article cited someone who found therapy more useful given than the maximum dose of antidepressants didn’t help. He remarked that his therapist “helped me more in those weeks than everything I had ever been offered in the three years I had been struggling” and wishing he had been offered therapy sooner [2].


As for the exercise recommendation, it’s long been known exercise is beneficial for mental health and a Swedish study this year confirmed that notion even more. Tracking 395,369 people to compare long-distance skiiers versus a control group, they found the former had a 60% lower chance of developing anxiety disorders compared to the latter [5]. Of course there are not many ski slopes in the UK, so the preferred exercise recommendation is often yoga, with its poses loosening muscles that can be tight from anxiety and its breathing routines stimulating the vagus nerve. [4] Meanwhile for the subset of men for whom low testosterone is the root of their depression, there is some evidence that weightlifting is beneficial [3].


It is important not to dismiss antidepressants as they are still effective “50-65% of people treated with an antidepressant for depression will see an improvement, compared to 25-30% with a placebo” [4] and indeed for some patients they may prefer them over therapy. One woman interviewed said “I have tried CBT over the phone, but this didn’t work for me. My depression is purely the chemicals imbalanced in my brain and as I’d had it for so long and it’s hereditary – my parents have both suffered with depression – I will have it forever and the medication is counter acting the imbalance. [2]”


Nevertheless that still leaves 35-50% of people for whom antidepressants simply do not work. Many are concerned also about the negative side effects that can leave some in worse positions than they started out. In addition there is long ignored research indicating the mechanism of antidepressants is unclear, and that the belief that depression is the result of low serotonin in the brain is at best highly simplified [7].


In conclusion there are lots of treatment paths that work but none of them are appropriate for everyone. It’s important that we work to improve access to a diversity of treatment options, and that doctors present these options to them in line with these new recommendations.


CBT therapy and counselling is available at Surrey Therapy Practice. https://www.surreytherapypractice.com/therapy-services.


References

1. https://www.nice.org.uk/news/nice-creates-new-menu-of-treatment-options-for-those-suffering-from-depression

2. https://inews.co.uk/news/cbt-therapy-helped-more-than-anti-depressants-depression-nice-guidelines-1315176

3. https://www.webmd.com/men/features/exercise-and-testosterone

4. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6189422/

5. https://www.frontiersin.org/articles/10.3389/fpsyt.2021.714014/full?fbclid=IwAR1LCfjGHpp1GO4LWild7usliUyZVY998AdJQy1yMIEqpl7X9D4K-0Ey13M

6. https://www.nhsinform.scot/tests-and-treatments/medicines-and-medical-aids/types-of-medicine/antidepressants

7. https://www.theguardian.com/science/blog/2010/sep/28/depression-serotonin-neurogenesis