People with mild depression in England should be offered therapy, exercise, mindfulness or meditation before antidepressants.

The National Institute for Health and Care Excellence is recommending the “menu of treatment options” be offered to patients by health professionals before medication is considered.

The advice comes as Antidepressant use has soared in recent years, with more than 20m handed out to patients in just three months last year.

Patients with less severe depression could choose from the menu as a first-line treatment option from, for example, cognitive behavioural therapy (CBT), exercise, counselling or psychotherapy.

A similar range of psychological interventions, along with the option of antidepressant medication, is available to those choosing a first-line treatment for more severe depression.

Dr Paul Chrisp, director of the centre for guidelines at NICE, said: “People with depression deserve and expect the best treatment from the NHS which is why this guideline is urgently required.

“The COVID-19 pandemic has shown us the impact depression has had on the nation’s mental health. People with depression need these evidence-based guideline recommendations available to the NHS, without delay.”

According to the Office of National Statistics, around one in six (17%) adults aged 16 years and over in Great Britain experienced some form of depression in summer 2021. The rate remains higher than those observed before the coronavirus pandemic (July 2019 to March 2020), where 10% of adults experienced some form of depression.

Nav Kapur, professor of psychiatry and population health at the University of Manchester and chair of the guideline committee, said: “This is a broad ranging guideline on depression which has been an enormous challenge to produce.

“In particular we’ve emphasised the role of patient choice – suggesting that practitioners should offer people a choice of evidence-based treatments and understanding that not every treatment will suit every person. We now need stakeholders’ help to make the recommendations as good as they can possibly be.”

Retired solicitor Catherine Ruane, a lay member on the guideline committee who acted as a carer to two family members with depression, said: “There has been significant progress in science and medicine in the past 12 years. This guideline emphasises a greater amount of patient choice and takes greater account of the things that really matter to the patients and their carers.”


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