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Depression: The Treatment and Management of Depression in Adults (Updated Edition)

Depression: The Treatment and Management of Depression in Adults (Updated Edition)

NICE Clinical Guidelines - National Collaborating Centre for Mental Health (UK)

Version: 2010

THE PHARMACOLOGICAL AND PHYSICAL MANAGEMENT OF DEPRESSION THAT HAS NOT ADEQUATELY RESPONDED TO TREATMENT, AND RELAPSE PREVENTION

In this chapter, sections marked by asterisks (**__**) are from the previous guideline and have not been updated except for style and minor clarification.

FACTORS INFLUENCING CHOICE OF ANTIDEPRESSANTS

This chapter updates the reviews on the effect of sex on antidepressant choice, antidepressant discontinuation symptoms, cardiotoxicity of antidepressants, and antidepressants and suicide. It includes a new review of treatments for depression with a seasonal pattern because this diagnosis was added to the scope of the updated guideline.

INTRODUCTION TO PHARMACOLOGICAL AND PHYSICAL INTERVENTIONS

For the guideline update the following reviews of pharmacological interventions are updated: escitalopram, relapse prevention and next-step treatments (treatments for treatment-resistant depression in the previous guideline), and the following narrative reviews have been updated with new data: effect of sex on antidepressant choice, dosage, discontinuation, cardiotoxicity, and antidepressants and suicide. There are also new reviews for TCAs, duloxetine and therapies for depression with a seasonal pattern, new narrative reviews of transcranial magnetic stimulation (TMS) and vagus nerve stimulation (VNS), and new sections for chronic depression and residual symptoms. The scope for the update also includes updating the NICE technology appraisal on the use of ECT (for depression) (TA59; NICE, 2003) 74 Recommendations from TA59 were incorporated into the previous depression guideline according to NICE protocol. . Where reviews have not been updated, an explanation has been added to the relevant chapter introduction.

SUMMARY OF RECOMMENDATIONS

Inform people with depression about self-help groups, support groups and other local and national resources.

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