The National Institute for Clinical Excellence (NICE) has today issued guidelines for the NHS on the treatment and care
of people with depression and anxiety. The guidelines take account of today's announcement by the Medicines and Healthcare
products Regulatory Agency (MHRA) on the safety of anti-depressant drug treatments and will support health professionals when
implementing the MHRA's advice. The guidelines also recommend effective psychological treatments for people with depression
and anxiety and will set national standards for care across England and Wales.
Depression is characterised by a low mood and loss of interest, usually accompanied by one or more of the following - low energy; change in appetite, weight or sleep pattern; poor concentration; feelings of guilt or worthlessness and suicidal ideas. The guideline on depression recommends that for mild and moderate depression, psychological treatments specifically focused on depression (such as problem-solving therapy, cognitive behaviour therapy (CBT) and counselling) can be as effective as drug treatments and should be offered as treatment options.
The guideline also recommends that:
-- Antidepressants should not be used for the initial treatment of mild depression, because the risk-benefit ratio is poor.
-- Where antidepressants are prescribed for moderate or severe depression it should be a selective serotonin reuptake inhibitor (SSRI), because SSRIs are as effective as tricyclic antidepressants and their use is less likely to be discontinued because of side-effects
-- All patients prescribed antidepressants should be informed that, although the drugs are not associated with tolerance and craving, discontinuation/withdrawal symptoms may occur on stopping or missing doses or, occasionally, on reducing the dose of the drug.
-- Screening for all high risk groups - for example, those with a past history of depression, significant physical illnesses causing disability, or other mental health problems such as dementia.
-- For severe depression, psychological treatment (CBT) should be used in combination with anti-depressant medication.
Anxiety is characterised by feelings of apprehension and worry, spontaneous panic attacks, irritability, poor sleeping, avoidance and poor concentration. The guideline on anxiety recommends that patients should be offered any of the following three types of intervention, taking into account patient preference. In descending order of long term effectiveness, these interventions are:
-- Psychological therapy, such as CBT.
-- Medication, such as an SSRI licensed for generalised anxiety disorder.
-- Self help, such as bibliotherapy (the use of written materials) based on CBT principles.
The guideline also recommends that:
-- Involving individuals in an effective partnership with healthcare professionals, with all decision making being shared, improves outcomes.
-- Access to information, including support groups, is a valuable part of any package of care.
-- There are positive advantages of services for people with anxiety being based in primary care rather than in a hospital setting.
Andrew Dillon, Chief Executive of NICE and Executive Lead for both guidelines said: "These guidelines provide an important step forward in improving the diagnosis, treatment and care of people with depression and anxiety. The guidelines recognise that whilst medication has an important role to play in treating these conditions, there are also many effective alternatives."
Stephen Pilling, Consultant Clinical Psychologist and Co-Director of the National Collaborating Centre for Mental Health which developed the guideline on depression said: "There is a solid base of evidence to show that psychological therapies can work as well as drug treatments for treating depression and that they have fewer side effects. The guideline reflects this fact. I hope this guideline will lead to better awareness of the problems faced by people with depression and help health professionals to offer the right assessment, treatment and follow up."
Dr Alan Cohen, General Practitioner and Chair of the anxiety guideline development group said: "Anxiety is a common condition which can have a severe impact on a person's quality of life. Fortunately there are effective treatments available, both pharmacological and psychological, and the decision as to which treatments to use should be a decision made in partnership between the health professional and their patient."
Lilian Owens Chair of "No Panic" patient support group and member of the anxiety guideline development group said: "Ensuring that people with anxiety and depression are fully informed about their treatment options and understand what is happening to them whilst in NHS care is essential. The guideline clearly highlights the importance of providing full information about treatment options available and making all efforts necessary to ensure that someone who has anxiety or depression is jointly and actively involved in decision making about their treatment."
Ends
For more information call Fraser Woodward on 020 7067 5905 or 07879 846 787
Notes to Editors
About clinical guidelines
1. Clinical guidelines are recommendations on the appropriate treatment and care of patients with specific diseases and conditions within the NHS in England and Wales. They sit alongside, but do not replace, the knowledge and skills of experienced health professionals.
2. The guideline on depression was developed for NICE by the National Collaborating Centre for Mental Health, a professionally-led group with the experience and resources to develop guidance for the NHS on behalf of NICE. The National Collaborating Centre for Mental Health is led jointly by the British Psychological Society and the Royal College of Psychiatrists.
3. The guideline on anxiety was developed for NICE by the National Collaborating Centre for Primary Care, a professionally-led group with the experience and resources to develop guidance for the NHS on behalf of NICE. The National Collaborating Centre for Primary Care is led by the Royal College of General Practitioners.
4. The Collaborating Centres follow international standards of guideline development. They establish an independent group to develop each guideline consisting of representatives of people with the condition, health professionals working in the NHS and health service researchers. The group reviews the published clinical research alongside current clinical practice and the experience of people with the condition. Professional and patient/carer groups whose members are likely to be affected by the guideline were able to submit information and comment on the recommendations before they were finalised.
About NICE
5. NICE is part of the NHS. It is the independent organisation responsible for providing national guidance on treatments and care for those using the NHS in England and Wales. Its guidance is for healthcare professionals and patients and their carers to help them make decisions about treatment and healthcare. For further information about NICE you can visit http://www.nice.org.uk.
6. NICE produces guidance in three areas of health:
-- the use of new and existing medicines and treatments within the NHS in England and Wales - technology appraisals.
-- the appropriate treatment and care of patients with specific diseases and conditions within the NHS in England and Wales - clinical guidelines.
-- whether interventional procedures used for diagnosis or treatment are safe enough and work well enough for routine use- interventional procedures.
NICE also funds three enquiries that undertake research into the way patients are treated to identify ways of improving the quality of care (the investigations are known as confidential enquiries).
7. NICE guidance and recommendations are prepared by independent groups that include professionals working in the NHS and people who are familiar with the issues affecting patients and carers.
Obtaining copies of the guidelines
8. Electronic copies of the quick reference guide to the depression guideline can be found on the NICE website at www.nice.org.uk/CG023quickrefguide and electronic copies of the information for the public leaflet that accompanies the guideline can be found at http://www.nice.org.uk/CG023publicinfo.
9. Electronic copies of the quick reference guide to the anxiety guideline can be found on the NICE website at http://www.nice.org.uk/CG022quickrefguide and electronic copies of the information for the public leaflet that accompanies the guideline can be found at http://www.nice.org.uk/CG022publicinfo.
10. Hard copies of both guidelines will be distributed to the NHS on 15th December and will be available to order from the NHS response line on 0870 1555 455 from that date, by quoting the following reference numbers :
-- NO763 - anxiety quick reference guide
-- NO764 - anxiety information for the public (English)
-- NO765 - anxiety information for the public (English and Welsh bilingual)
-- NO766 - depression quick reference guide
-- NO767 - depression information for the public (English)
-- NO768 - depression information for the public (English and Welsh bilingual)
About the Medicines and Healthcare products Regulatory Agency (MHRA)
11. The MHRA is the executive arm of the UK's Drug Licensing Authority and is responsible for all aspects of the regulation of medicines in the UK. The MHRA is advised by the Committee for the Safety of Medicines (CSM) - an independent Committee of scientific experts that advise Government on the safety, quality and effectiveness of medicines, including vaccines. The CSM is also responsible for promoting the collection and investigation of reports on suspected adverse reactions to medicines already on the market. In April 2003, the CSM established an Expert Working Group to consider the safety of Selective Serotonin Reuptake Inhibitors (SSRIs), used for the treatment of depressive illness and anxiety disorders since the late 1980s. The Group incorporates specialist experts in the clinical management of depressive illness in childhood and adolescence. The findings of the CSM's Expert Working Group have been accepted by the MHRA and regulatory action to amend the marketing authorisations for all the products affected has been initiated by the MHRA and will be carried through as a matter of urgency. More information on the MHRA, CSM and their advice, can be found on http://www.mhra.gov.uk.
About No Panic
12. No Panic is an International Self Help Charity offering a range of information and services for those people who suffer with anxiety disorders. No Panic is 95% user led and service provision is driven by experts who have experienced an anxiety disorder. for further information please contact http://www.nopanic.org.uk
National Institute for Clinical Excellence
(NICE)
Mid City Place
71 High Holborn
London
WC1V 6NA
Tel: 020 7067 5800
Fax: 020 7067 5801
nice@nice.nhs.uk
http://www.nice.org.uk
Depression is characterised by a low mood and loss of interest, usually accompanied by one or more of the following - low energy; change in appetite, weight or sleep pattern; poor concentration; feelings of guilt or worthlessness and suicidal ideas. The guideline on depression recommends that for mild and moderate depression, psychological treatments specifically focused on depression (such as problem-solving therapy, cognitive behaviour therapy (CBT) and counselling) can be as effective as drug treatments and should be offered as treatment options.
The guideline also recommends that:
-- Antidepressants should not be used for the initial treatment of mild depression, because the risk-benefit ratio is poor.
-- Where antidepressants are prescribed for moderate or severe depression it should be a selective serotonin reuptake inhibitor (SSRI), because SSRIs are as effective as tricyclic antidepressants and their use is less likely to be discontinued because of side-effects
-- All patients prescribed antidepressants should be informed that, although the drugs are not associated with tolerance and craving, discontinuation/withdrawal symptoms may occur on stopping or missing doses or, occasionally, on reducing the dose of the drug.
-- Screening for all high risk groups - for example, those with a past history of depression, significant physical illnesses causing disability, or other mental health problems such as dementia.
-- For severe depression, psychological treatment (CBT) should be used in combination with anti-depressant medication.
Anxiety is characterised by feelings of apprehension and worry, spontaneous panic attacks, irritability, poor sleeping, avoidance and poor concentration. The guideline on anxiety recommends that patients should be offered any of the following three types of intervention, taking into account patient preference. In descending order of long term effectiveness, these interventions are:
-- Psychological therapy, such as CBT.
-- Medication, such as an SSRI licensed for generalised anxiety disorder.
-- Self help, such as bibliotherapy (the use of written materials) based on CBT principles.
The guideline also recommends that:
-- Involving individuals in an effective partnership with healthcare professionals, with all decision making being shared, improves outcomes.
-- Access to information, including support groups, is a valuable part of any package of care.
-- There are positive advantages of services for people with anxiety being based in primary care rather than in a hospital setting.
Andrew Dillon, Chief Executive of NICE and Executive Lead for both guidelines said: "These guidelines provide an important step forward in improving the diagnosis, treatment and care of people with depression and anxiety. The guidelines recognise that whilst medication has an important role to play in treating these conditions, there are also many effective alternatives."
Stephen Pilling, Consultant Clinical Psychologist and Co-Director of the National Collaborating Centre for Mental Health which developed the guideline on depression said: "There is a solid base of evidence to show that psychological therapies can work as well as drug treatments for treating depression and that they have fewer side effects. The guideline reflects this fact. I hope this guideline will lead to better awareness of the problems faced by people with depression and help health professionals to offer the right assessment, treatment and follow up."
Dr Alan Cohen, General Practitioner and Chair of the anxiety guideline development group said: "Anxiety is a common condition which can have a severe impact on a person's quality of life. Fortunately there are effective treatments available, both pharmacological and psychological, and the decision as to which treatments to use should be a decision made in partnership between the health professional and their patient."
Lilian Owens Chair of "No Panic" patient support group and member of the anxiety guideline development group said: "Ensuring that people with anxiety and depression are fully informed about their treatment options and understand what is happening to them whilst in NHS care is essential. The guideline clearly highlights the importance of providing full information about treatment options available and making all efforts necessary to ensure that someone who has anxiety or depression is jointly and actively involved in decision making about their treatment."
Ends
For more information call Fraser Woodward on 020 7067 5905 or 07879 846 787
Notes to Editors
About clinical guidelines
1. Clinical guidelines are recommendations on the appropriate treatment and care of patients with specific diseases and conditions within the NHS in England and Wales. They sit alongside, but do not replace, the knowledge and skills of experienced health professionals.
2. The guideline on depression was developed for NICE by the National Collaborating Centre for Mental Health, a professionally-led group with the experience and resources to develop guidance for the NHS on behalf of NICE. The National Collaborating Centre for Mental Health is led jointly by the British Psychological Society and the Royal College of Psychiatrists.
3. The guideline on anxiety was developed for NICE by the National Collaborating Centre for Primary Care, a professionally-led group with the experience and resources to develop guidance for the NHS on behalf of NICE. The National Collaborating Centre for Primary Care is led by the Royal College of General Practitioners.
4. The Collaborating Centres follow international standards of guideline development. They establish an independent group to develop each guideline consisting of representatives of people with the condition, health professionals working in the NHS and health service researchers. The group reviews the published clinical research alongside current clinical practice and the experience of people with the condition. Professional and patient/carer groups whose members are likely to be affected by the guideline were able to submit information and comment on the recommendations before they were finalised.
About NICE
5. NICE is part of the NHS. It is the independent organisation responsible for providing national guidance on treatments and care for those using the NHS in England and Wales. Its guidance is for healthcare professionals and patients and their carers to help them make decisions about treatment and healthcare. For further information about NICE you can visit http://www.nice.org.uk.
6. NICE produces guidance in three areas of health:
-- the use of new and existing medicines and treatments within the NHS in England and Wales - technology appraisals.
-- the appropriate treatment and care of patients with specific diseases and conditions within the NHS in England and Wales - clinical guidelines.
-- whether interventional procedures used for diagnosis or treatment are safe enough and work well enough for routine use- interventional procedures.
NICE also funds three enquiries that undertake research into the way patients are treated to identify ways of improving the quality of care (the investigations are known as confidential enquiries).
7. NICE guidance and recommendations are prepared by independent groups that include professionals working in the NHS and people who are familiar with the issues affecting patients and carers.
Obtaining copies of the guidelines
8. Electronic copies of the quick reference guide to the depression guideline can be found on the NICE website at www.nice.org.uk/CG023quickrefguide and electronic copies of the information for the public leaflet that accompanies the guideline can be found at http://www.nice.org.uk/CG023publicinfo.
9. Electronic copies of the quick reference guide to the anxiety guideline can be found on the NICE website at http://www.nice.org.uk/CG022quickrefguide and electronic copies of the information for the public leaflet that accompanies the guideline can be found at http://www.nice.org.uk/CG022publicinfo.
10. Hard copies of both guidelines will be distributed to the NHS on 15th December and will be available to order from the NHS response line on 0870 1555 455 from that date, by quoting the following reference numbers :
-- NO763 - anxiety quick reference guide
-- NO764 - anxiety information for the public (English)
-- NO765 - anxiety information for the public (English and Welsh bilingual)
-- NO766 - depression quick reference guide
-- NO767 - depression information for the public (English)
-- NO768 - depression information for the public (English and Welsh bilingual)
About the Medicines and Healthcare products Regulatory Agency (MHRA)
11. The MHRA is the executive arm of the UK's Drug Licensing Authority and is responsible for all aspects of the regulation of medicines in the UK. The MHRA is advised by the Committee for the Safety of Medicines (CSM) - an independent Committee of scientific experts that advise Government on the safety, quality and effectiveness of medicines, including vaccines. The CSM is also responsible for promoting the collection and investigation of reports on suspected adverse reactions to medicines already on the market. In April 2003, the CSM established an Expert Working Group to consider the safety of Selective Serotonin Reuptake Inhibitors (SSRIs), used for the treatment of depressive illness and anxiety disorders since the late 1980s. The Group incorporates specialist experts in the clinical management of depressive illness in childhood and adolescence. The findings of the CSM's Expert Working Group have been accepted by the MHRA and regulatory action to amend the marketing authorisations for all the products affected has been initiated by the MHRA and will be carried through as a matter of urgency. More information on the MHRA, CSM and their advice, can be found on http://www.mhra.gov.uk.
About No Panic
12. No Panic is an International Self Help Charity offering a range of information and services for those people who suffer with anxiety disorders. No Panic is 95% user led and service provision is driven by experts who have experienced an anxiety disorder. for further information please contact http://www.nopanic.org.uk
National Institute for Clinical Excellence
(NICE)
Mid City Place
71 High Holborn
London
WC1V 6NA
Tel: 020 7067 5800
Fax: 020 7067 5801
nice@nice.nhs.uk
http://www.nice.org.uk
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