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Depression

NICE guideline Depression in adults: treatment and management. Published: Jun 2022. NICE CKS Depression. Last revised: Apr 2025.

Guidelines

Offer either of the following as 1st line:

Active monitoring, with option to consider treatment at any time if needed
Guided self-help

Do not routinely offer antidepressants as 1st line, but if the person wishes, offer SSRI as 1st line

Other treatment options to consider (in descending order of appropriateness)

Group CBT
Group behavioural activation
Individual CBT
Individual behavioural activation
Group exercise
Group mindfulness and meditation
Interpersonal psychotherapy
SSRIs
Counselling
Short-term psychodynamic psychotherapy

1st line:

CBT, and
Antidepressant

Note that antidepressant usually takes 4 weeks to start working

Consider switching antidepressants to any of the following classes:

SSRI
SNRI
TCA (only in secondary care)
MAO-I (only in secondary care)

Consider combination treatment by adding:

Another antidepressant class - mirtazapine, or trazodone
2nd generation antipsychotic (e.g. olanzapine, aripiprazole, quetiapine)
Lithium

Vortioxetine is recommended as an option if no or limited response to 2 antidepressants

Consider electroconvulsive therapy if:

Patient chooses
Rapid response is needed (e.g. life-threatening depression due to refusal to eat or drink)
Other treatments have been unsuccessful

References

NICE guideline Depression in adults: treatment and management
NICE CKS Depression

Author: Adams Lau
Reviewer:
Last edited: 25/07/25

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