Depression in Adults: Treatment and Management (NICE NG222)

NICE NG222 (2022) significantly updated depression guidance, moving away from the stepped-care severity model to a more person-centred approach offering choice of treatments.

Key Recommendations

• No longer classify as mild/moderate/severe — assess individual need, preference, and severity
• Offer a choice of interventions including psychological therapy, antidepressants, or self-management
• If prescribing, SSRIs first-line — sertraline preferred (efficacy and tolerability evidence)
• Review at 2-4 weeks after starting medication
• Minimum 6 months antidepressant treatment after remission to prevent relapse
• For two or more episodes, discuss long-term treatment (minimum 2 years)
• Active monitoring: risk of suicide/self-harm — safety net plan at every contact