Therapy before drugs in new fight to beat depression

In the first new guidelines in how to treat depression in more than a decade, the NHS has suggested a new approach when it comes to milder cases of the illness. Therapy before drugs should be the order in which treatment is applied, with exercise, mindfulness and meditation all being on the list. 

Under the new draft guidance, the National Institute for Health and Care Excellence (Nice) recommends a “menu of treatment options” be offered to patients before medication is prescribed by doctors. As it stands, adults with mild depression are usually offered mild anti-depressants as a first step, or they can choose a high-intensity psychological intervention instead. 

The new guidelines are the first changes to the approach to treating depression since 2009. About one in six adults or 17% experienced some form of depression this summer, up from 10% before the pandemic hit. Depression is more likely to affect younger adults and women, the Office for National Statistics found. In 2019 a review of the adult population in England showed that 7.3 million people had been prescribed anti-depressants between 2017-2018. 

 Dr Paul Chrisp, director of the centre for guidelines at Nice, said: “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.”

When the new guidelines come into effect, people with milder depression will be offered group CBT cognitive behavioural therapy before drugs as a first treatment, dependant on their doctor’s opinion. CBT “focuses on how thoughts, beliefs, attitudes, feelings and behaviour interact, and teaches coping skills to deal with things in life differently”. 

There are seven different treatments that could be used as a follow up to these sessions, including self-help, group meditation, or group exercise, before medication would be offered. The guideline adds: “Do not routinely offer antidepressant medication as first-line treatment for less severe depression unless that is the person’s preference.”

Figures from the NHS Business Services Authority show more than 20 million antidepressants were prescribed between October and December 2020 – a 6% increase compared with the same three months in 2019.

“There has been significant progress in science and medicine in the past 12 years,” said retired solicitor Catherine Ruane, a lay member on the guideline committee who acted as a carer to two family members with depression. “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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