NICE guidelines for the treatment of depression

Clinical Question

How should primary care physicians treat patients with symptoms of depression?

Bottom line

Refreshingly, these guidelines are labeled as information for not only health professionals, but also for people with depression, their families, and caregivers. The authors emphasize that, other than in the presence of suicidal ideation and intent, the diagnosis of depression is more than simply ticking boxes. They also highlight the primacy of an ongoing relationship between clinician and patient to make the diagnosis and to decide, together, on the best treatment. For less severe depression, guided self-help, group or individual therapies, or other nondrug treatments are first-line therapy; drug treatment comes in ninth of 11 options. CBT and drug treatment, together or alone, are starting points for the treatment of more severe depression. See the links in the synopsis for graphic overviews to share with your patients while you are discussing treatment. (LOE = 5)

Overuse alert: This POEM aligns with the Canadian Psychiatric Association’s Choosing Wisely Canada recommendation: Don’t routinely use antidepressants as first-line treatment for mild or subsyndromal depressive symptoms in adults.

Study design: Practice guideline

Funding: Government

Setting: Various (guideline)


Allen F. Shaughnessy, PharmD, MMedEd
Professor of Family Medicine
Tufts University
Boston, MA

Discuss this POEM



First options for depression

Good review


Where are the graphics?

I would love to use the graphics you mention. But there are no links to them in the synopsis.


Links to graphics were…

Links to graphics were omitted from this POEM in error, they have been added. Please accept our sincere apologies for any inconvenience this caused.


Thank god (even though I’m an atheist)

Finally some common sense. Build relationships, therapeutic alliance, not just pills as treatment.



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Theresa Clare Girvin

If the patient can read these 103 pages and collaborate in c

When can anyone get even the moderately severely depressed patient to read 103-page tome on their treatment? I would say this is more useful for providers than for patients unless they are mildly depressed, in which case, skip the medication management.


depression in primary care pts

many options to treat and not necessary to start antidepressants as first rx


Impact assessment

Very good