Learning Objectives
- Apply the revised NICE stepped-care model for depression
- Understand changes to antidepressant prescribing recommendations
- Know when to refer to secondary mental health services
- Screen for and manage co-morbid anxiety
Key Changes in NG222
NICE moved away from classifying depression as mild/moderate/severe, replacing this with a more holistic view of the person’s needs and preferences.
Treatment Options
NICE now recommends offering a choice of interventions — not following a fixed stepped-care sequence. Options for less severe depression include:
- Individual guided self-help
- Group CBT or exercise groups
- Brief psychological therapies
- Antidepressants (if preferred by patient)
Antidepressants
If prescribing, NICE recommends:
- SSRIs as first-line (sertraline preferred due to evidence and safety profile)
- Review response after 3-4 weeks
- If partial response, optimise dose before switching
- Minimum treatment duration: 6 months after remission
Monitoring and Safety
- Assess suicide risk at each appointment during initiation
- Warn about activation symptoms in first 2 weeks
- Review antidepressants annually if long-term use