Response to the NICE clinical guideline on depression

McQueen, Daniel (2009) Response to the NICE clinical guideline on depression. Discussion Paper. British Psychoanalytic Council, London. Full text available

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The National Institute for Health and Clinical Excellence (NICE) this year updated The NICE clinical guideline for the treatment of depression in adults. The British Psychoanalytic Council, Association for Psychoanalytic Psychotherapy in the NHS, Anna Freud Centre, and Tavistock and Portman NHS Foundation Trust as a group contributed to the consultation, cautiously welcoming the draft, but disagreed with the way that NICE had assembled its evidence, favouring CBT at the expense of other psychological therapies. The NICE Guideline on Depression in Adults makes clear the complex nature of depression and its clinical and social importance.It highlights the important role of psychological therapies in the treatment of depressive disorders. It recognises the importance of maintaining a plurality of treatment and not withdrawing established psychotherapies. The scope of the guideline is limited by a narrow, undifferentiated and simplistic conception of depression. It unhelpfully restricts itself to randomised controlled trials, and excludes naturalistic trials despite their advantages in assessing psychotherapeutic treatments and treatments in the real world. The evidence of the lasting effects of long-term psychotherapy in depression is not reviewed despite the evidence that depression is frequently chronic or recurring and the evidence of the limited effect of short-term treatments. The guideline fails to consider the importance of individual patient preferences or different types of depression, leading to restrictive and misleading one-size-fits-all recommendations. The evidence presented, in keeping with the scientific literature, demonstrates equivalence between Cognitive Behavioural, Interpersonal, and Short Term Psychodynamic Psychotherapies. The guideline misleads by recommending CBT based on the number of studies supporting it. CBT for depression provided through the Improving Access to Psychological Therapies services has not to date shown itself more effective or acceptable to patients in the real world than non-CBT therapies. There is an urgent need for well-funded trials to explore if those who do not respond to CBT can benefit from other forms of treatment including psychodynamic psychotherapy and the extent to which long-term treatments have superior outcomes in the medium or long-term.

Item Type: Monograph (Discussion Paper)
Subjects: Disabilities & Disorders (mental & physical) > Depression
Psychological Therapies, Psychiatry, Counselling > Psychoanalytic Psychotherapy
Department/People: Children, Young Adult and Family Services

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