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National Collaborating Centre for Mental Health (UK). Depression: The Treatment and Management of Depression in Adults (Updated Edition). Leicester (UK): British Psychological Society; 2010. (NICE Clinical Guidelines, No. 90.)

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

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APPENDIX 7CLINICAL QUESTIONS

Clinical questions for Depression Update GuidelineClinical question in previous guideline
AService configuration for people with depression
A1What methods are effective in identifying people with depression in primary care and community settings, including sexual health clinics, emergency departments, and drug and alcohol services?
In which populations (excluding those with chronic physical health problems) should identification methods be used?
A1
A2In the treatment of depression (major depressive disorder, dysthymia, subthreshold depression and subthreshold depressive symptoms), which models of care produce the best outcomes?

collaborative care

stepped care

case management

stratified (matched) care

attached professional model

Are different models appropriate to the care of people in different phases of the illness, such as treatment resistant depression and relapse prevention?
A5
BPsychology/psychosocial interventions for people with depression
B1In depression, does guided self-help improve outcomes compared with other interventions?A2
B2Does computerised CBT (CCBT) improve patient outcomes compared with other treatments?A3
B3In the treatment of depression (major depressive disorder, dysthymia, subthreshold depression and subthreshold depressive symptoms), do any of the following improve outcomes compared with other interventions?

exercise

support including groups, befriending, and non-statutory provision

programmes to facilitate employment

A4
B4Do non-statutory support groups improve outcomes?A6
B5In the treatment of depression (major depressive disorder, dysthymia, subthreshold depression and subthreshold depressive symptoms), do any of the following (either alone or in combination with pharmacotherapy) improve outcomes compared with other interventions (including treatment as usual):

CBT

BT/behavioural activation

counselling/person-centred therapy

problem solving

psychodynamic psychotherapy

family interventions/couples therapy

ACT (acceptance and commitment therapy)

systemic interventions

psychoeducation

cognitive analytic therapy (CAT)

solution-focused therapy

self-help, including guided self-help

CCBT

Does mode of delivery (group-based or individual) impact on outcomes?
Are there specific therapist characteristics that improve outcomes?
Are there specific patient characteristics (for example, anxiety, previous episodes) that predict outcomes?
Are brief interventions (for example, 6 to 8 weeks) effective?
Are psychological interventions harmful?
B1
B2
B6Following poor response to treatment of depression (major depressive disorder, dysthymia, subthreshold depression and subthreshold depressive symptoms), which psychological or psychosocial interventions are appropriate?
B7In people whose depression has responded to treatment, what psychological and psychosocial strategies are effective in preventing relapse (including maintenance treatment)?
CPharmacological/physical interventions
C1In the treatment of depression (major depressive disorder, dysthymia, subthreshold depression and subthreshold depressive symptoms), which drugs (either not covered by the previous guideline or where significant new evidence exists) improve outcomes compared with other drugs and with placebo?

TCAs

duloxetine

desvenlafaxine

escitalopram

agomelatine

St John’s wort

antipsychotics (for example, quetiapine)

C1
C2In the treatment of depression (major depressive disorder, dysthymia, subthreshold depression and subthreshold depressive symptoms), to what extent do the following factors affect the choice of drug?

adverse events (in particular, cardiotoxicity), including long-term adverse events

discontinuation problems

C2
C3In the pharmacological treatment of depression, what are the most effective strategies for treating patients experiencing treatment side effects, including sexual dysfunction and weight gain?C3
C4In people whose depression has responded to treatment, what strategies are effective in preventing relapse (including maintenance treatment)?C6
C5In people whose depression has atypical features, what are the most effective treatment strategies?C6
C6In the treatment of depression (major depressive disorder, dysthymia, subthreshold depression and subthreshold depressive symptoms), do any of the following improve outcomes compared with other interventions?

ECT

TMS (integrate NICE Interventional Procedure Guidance)

light therapy

VNS

neurosurgery

deep brain stimulation

C7
A9
C7For people with depression (major depressive disorder, dysthymia, and so on), who are receiving pharmacological treatment, does therapeutic drug monitoring improve outcomes?
C8What are appropriate ways to promote adherence? (Link to NICE guideline on medicines adherence, CG76)
C9In the treatment of depression (major depressive disorder, dysthymia, subthreshold depression and subthreshold depressive symptoms), how can equal access to services for all be ensured? [What promotes access to effective care particularly for people with learning difficulties, acquired cognitive impairment and language difficulties?]A9
DGeneral
D1In the treatment of depression, which patient characteristics predict response and relapse? For example, childhood trauma, age of onset, number of previous episodes, gender, and so on.
D2In the treatment of depression, are there specific clinician approaches that improve outcomes?
Copyright © The British Psychological Society & The Royal College of Psychiatrists, 2010.

All rights reserved. No part of this book may be reprinted or reproduced or utilised in any form or by any electronic, mechanical, or other means, now known or hereafter invented, including photocopying and recording, or in any information storage or retrieval system, without permission in writing from the publishers. Enquiries in this regard should be directed to the British Psychological Society.

Bookshelf ID: NBK63767

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