In June 2022, NICE updated its guideline on the diagnosis and management of depression, providing new recommendations highly relevant to primary care. This update emphasizes the importance of shared decision-making, respect for patient autonomy, and careful consideration of mental capacity and medicines management. Health and social care professionals are reminded to adhere to NICE’s broader standards for safe and effective care delivery, including in areas such as medicines adherence, multimorbidity, and service user experience in mental health.
The guideline also introduces a revised approach to defining depression severity, recognizing it as a continuum influenced by symptom intensity, duration, and functional impact. Rather than the traditional four categories (subthreshold, mild, moderate, and severe), depression is now classified more simply as "less severe" (subthreshold and mild) or "more severe" (moderate and severe). Validated scales, such as the PHQ-9, are recommended for assessing severity, with a threshold score of 16 distinguishing between less and more severe depression.
Quick Glance: NICE Depression Management Pathway for GPs
1. Initial Assessment
- Identify core depression symptoms (low mood, loss of interest).
- Assess severity, duration, impact, and risk factors.
2. Risk and Safety Assessment
- Assess suicidality, self-harm, self-neglect risk.
- Urgent referral if immediate danger.
3. First-Line Treatment
- Less severe depression: Guided self-help, group CBT/BA, exercise.
- More severe depression: Combination of antidepressant + individual CBT/BA.
4. Non-Response Management
- Check adherence, barriers, misdiagnosis.
- If no improvement at 4–6 weeks ➔ switch/add therapy or medication.
5. Special Cases
- Chronic symptoms: CBT focused on chronicity, medication switch if needed.
- Personality disorder + depression: Combined approach (medication + therapy).
- Psychotic depression: Specialist referral; combination treatment.
- ECT: Severe, life-threatening, or past positive response.
6. Crisis and Inpatient Care
- CRHT for suicide/self-harm risk.
- Inpatient care if CRHT not sufficient.
7. Long-Term Management
- Continue antidepressants/therapy to prevent relapse.
- 6-monthly medication reviews; escalate if needed.
- Specialist referral if complex social/health needs.
8. Terms to Know
- Collaborative Care: Integrated, multidisciplinary support.
- Routine Outcome Monitoring: PHQ-9/session tracking.
- Stepped/Matched Care: Least intrusive first, escalate as required.
This refreshed approach aims to better support clinical decision-making and ensure that care is appropriately tailored to the individual's needs, improving outcomes across diverse primary care settings.
Now let us look section by section for better understanding
Depression NICE Guideline - Condensed Flowchart
1.1 Principles of Care
Reduce stigma, provide evidence-based information, and plan ahead with the person.
↓
1.2 Recognition and Assessment
- Screen for depression using 2 key questions.
- Refer if not competent; assess if competent.
- Use validated symptom and function measures.
- Adjust approach for communication needs.
↓
1.2 Initial Assessment
Conduct a comprehensive assessment considering:
- Severity, history, duration, functional impact.
- Past depression, bipolar symptoms, previous treatments.
- Personal strengths, support networks, relationship issues.
- Lifestyle factors, trauma/stress, living conditions, substance use, social isolation.
↓
1.2 Risk Assessment and Management
- Directly ask about suicidal ideation and intent.
- Arrange urgent help if needed.
- Monitor for increased agitation, anxiety, suicidal ideation early in treatment.
- Support family/carers in monitoring mood changes.
↓
1.2 Risk Assessment and Management
- Directly ask about suicidal ideation and intent.
- Assess social support and knowledge of help sources.
- Urgently refer if immediate risk is present.
- Warn about increased agitation, anxiety, suicidal ideation at treatment start/change.
- Advise patients and carers to monitor mood, especially at high-risk periods.
- Continue treating depression even if suicide risk is high.
- Limit medication quantities if overdose risk.
- Increase support contact if needed (in-person, video, phone).
- Refer to specialist mental health services if appropriate.
↓
1.2 Special Situations
- Depression with Anxiety:
- Usually treat depression first.
- If a formal anxiety disorder is present, consult NICE guidance for that disorder and consider treating anxiety first.
- Depression with Acquired Cognitive Impairments:
- Be alert to cognitive impairments during assessment.
- Consult specialists when needed for treatment planning.
- Offer standard depression treatments where possible, but adjust delivery methods if necessary (communication needs, disabilities).
- Refer to NICE dementia guideline if dementia is present.
↓
1.3 Choice of Treatments
- Discuss possible contributing factors and previous treatment experiences with the person.
- Explore the person's treatment preferences, hopes, and expectations.
- Foster continuity by enabling the person to see the same healthcare professional where possible; record preferences clearly.
- Offer information about NICE-recommended treatments, benefits, risks, expected outcomes, and delivery options (individual/group, in-person/remote).
- Allow for patient preferences regarding accompaniment by family/friend, healthcare professional's gender, or practitioner continuity.
- Commissioners must ensure timely access to preferred NICE-approved treatments, with monitoring for equality of provision and outcomes.
↓
1.4 Delivery of Treatments
🩺 All Treatments:
- Assess needs, develop a treatment plan, and consider physical and mental health comorbidities.
- Identify factors supporting engagement and address any barriers (e.g., language, disability).
- Ensure coordination between specialist and non-specialist care providers.
- Adjust treatment based on special groups (learning disabilities, autism, dementia, pregnancy, menopause, chronic physical health problems).
- Match treatment choice to clinical need, previous responses, and patient preference.
- Review progress between 2–4 weeks after starting treatment and monitor side effects, suicidal ideation, and treatment adherence.
- Use routine outcome measures (e.g., PHQ-9) to track progress where appropriate.
🧠 Psychological and Psychosocial Interventions:
- Inform people about waiting times and provide regular updates/support while waiting.
- Use treatment manuals to guide therapy structure and delivery.
- Ensure healthcare professionals have clinical supervision and competency evaluation (may include video/audio reviews with consent).
- Adapt interventions for people with neurodevelopmental or learning disabilities as needed.
- Prepare people at the end of psychological treatment to maintain their gains and promote ongoing wellness.
↓
Pharmacological treatments
Start: Consider Antidepressant Medication
Assess clinical need, patient preference, and prior history.
↓
Step 1: Shared Decision-Making
Discuss and agree:
- Reasons for medication
- Choices and dosing options
- Benefits and harms (side effects, withdrawal)
- Previous experiences and concerns
Provide written information.
↓
Step 2: Start Antidepressant
Provide instructions:
- Expected onset (within 4 weeks)
- First review (in 1–2 weeks)
- Monitor side effects, suicidal thoughts
- Advise on alcohol/medication interactions
↓
Step 3: Early Monitoring
Review symptoms and side effects at:
- 2 weeks for most
- 1 week if 18–25 years or suicide risk
Adjust if necessary.
↓
Step 4: Continue Treatment
- Continue if responding.
- Plan minimum 6 months post-remission.
- Monitor regularly using tools like PHQ-9.
↓
Step 5: Plan to Stop Antidepressant
When stable and appropriate:
- Discuss slow tapering (not abrupt stop)
- Explain possible withdrawal symptoms
- Provide ongoing support
↓
Step 6: Tapering and Withdrawal Management
- Reduce dose stepwise (e.g., 50% then 25%)
- Use liquid formulations if needed for small doses
- Go slower for paroxetine, venlafaxine (high withdrawal risk)
- Alternate-day dosing possible for fluoxetine
↓
Step 7: Manage Withdrawal Symptoms
- Mild symptoms: reassure and monitor
- Severe symptoms: reinstate last dose, slow taper further
- Explain difference between withdrawal vs relapse
↓
End: Monitor until Complete Withdrawal or Maintenance
Support recovery or reassess if relapse.
↓
Antidepressant medication for people at risk of suicide
Start: High-Risk Patient (18–25 yrs or Suicide Risk)
Thorough mental state assessment before prescribing (in person/video/phone).
↓
Step 1: Risk Management Plan
- Recognize early increased risk of suicidal thoughts and behaviors.
- Have a clear safety plan in place (liaise if needed).
↓
Step 2: Early Review (1 Week)
- Review suicidality within 1 week of starting or increasing dose.
- Prefer in-person; video/phone if necessary.
↓
Step 3: Ongoing Monitoring
- Review again within 4 weeks of starting treatment.
- Adapt frequency based on risk factors (e.g., life events, housing, support network).
↓
Step 4: Safe Prescribing Choice
- Consider overdose toxicity when choosing antidepressants.
- Avoid TCAs (except lofepramine) in high-risk individuals.
↓
End: Continue Treatment with Close Monitoring
Adjust treatment and safety plan based on ongoing risk assessments.
↓
1.4 Antidepressant Medication for Older People
- Review general physical health and comorbidities.
- Check for potential drug interactions with existing medications.
- Monitor carefully for side effects throughout treatment.
- Be vigilant about:
- Increased risk of falls and fractures
- Hyponatraemia, especially if on diuretics
- Refer to dementia guidelines if cognitive impairment is suspected or present.
↓
1.4 Lithium Use (Augmentation )
- Monitor renal, thyroid, and calcium function before starting and every 6 months (or more if renal risk).
- Special attention needed for women of reproductive age — discuss risks before pregnancy.
- Check serum lithium 12 hours post-dose; monitor weekly until stable, then:
- Every 3 months (first year)
- Every 6 months (after 1 year); 3 months if risk factors present (older adults, drug interactions, unstable levels).
- Maintain plasma lithium 0.4–1.0 mmol/L (lower end for age 65+).
- Watch for toxicity: diarrhoea, vomiting, tremor, confusion, ataxia, convulsions.
- Shared care with specialist teams; ECG if cardiovascular risk.
- Provide patients with safety info (e.g., NHS lithium pack).
- Only stop lithium gradually under specialist advice (over 1–3 months).
| Area |
Core Concepts |
| 🧪 Use of Oral Antipsychotics (Augmentation) |
- Baseline checks: pulse, BP, weight, nutritional status, glucose, HbA1c, lipids.
- Regular monitoring: bloods, ECG (if CVD risk), weight and metabolic profile.
- Watch for side effects: extrapyramidal symptoms, prolactin effects.
- Manage under shared care; review continuation regularly.
- Gradually taper over 4+ weeks if stopping; specialist advice needed.
|
| 🌿 Use of St John's Wort |
- Evidence suggests possible benefit in mild depression.
- Serious risks of drug interactions (e.g., contraceptives, anticoagulants).
- Do not prescribe or recommend due to dose variability and safety concerns.
|
| 🌞 Physical Treatments and Activities |
- Light therapy: patients can try if preferred, but evidence is uncertain.
- Regular physical activity (walking, gardening, swimming) boosts wellbeing; outdoor activity preferred.
- Healthy lifestyle (diet, sleep, limiting alcohol) promotes better mental health.
|
1.5 Treatment for a New Episode of Less Severe Depression
In this guideline, "less severe depression" refers to subthreshold symptoms and mild depression. Management focuses on offering flexible, patient-centred options.
For individuals who decline active treatment or are already improving, active monitoring is recommended, which includes supportive conversations, providing information about depression, and arranging timely reassessments (normally within 2–4 weeks). Ensuring patients know how to re-access help if needed is essential.
For individuals choosing treatment, NICE recommends offering a range of first-line therapies matched to their clinical needs and personal preferences. Treatments should start with the least intrusive and most resource-efficient options, such as guided self-help, progressing to more structured psychological interventions if needed.
Antidepressant medication should not be offered routinely as a first-line option unless it is specifically preferred by the person.
The table below summarises the core treatment options for less severe depression.
| Treatment Type |
Delivery & Key Concepts |
| 📚 Guided Self-Help |
Structured CBT or BA materials with practitioner support.
6–8 sessions. Flexible. Needs motivation. Avoids medication side effects.
|
| 👥 Group CBT / Group BA |
Group sessions (8 participants).
8 sessions. Peer support. Structured, practical. Homework involved. No medication side effects.
|
| 🧠 Individual CBT / BA |
One-to-one sessions.
Focus on thoughts (CBT) or behaviours (BA). 8+ sessions. Good for those preferring privacy. Structured.
|
| 🏃 Group Exercise |
Moderate aerobic activity in groups.
10+ weeks. Enhances wellbeing. Needs physical ability and time commitment.
|
| 🧘 Mindfulness-Based Group |
Mindfulness techniques in groups (8–15 people).
Focus on awareness rather than changing thoughts. Requires commitment to practice.
|
| 💬 Interpersonal Therapy (IPT) |
Individual therapy targeting relationship issues.
8–16 sessions. Structured. Good for those with interpersonal triggers.
|
| 💊 SSRIs |
Antidepressant medication.
Benefits in 4 weeks. Regular reviews needed. Risk of side effects and withdrawal.
|
| 🎧 Counselling |
Individual emotional support and exploration therapy.
8+ sessions. Suitable for psychosocial stressors. Not advice-based.
|
| 🔎 Short-Term Psychodynamic Psychotherapy (STPP) |
Individual sessions exploring emotional conflicts and relationships.
8–16 sessions. Focus on emotional patterns. Can be distressing initially.
|
1.6 Treatment for a New Episode of More Severe Depression
In this guideline, "more severe depression" encompasses what was traditionally classified as moderate and severe depression.
Management of more severe depression requires a comprehensive and collaborative approach, offering a range of evidence-based treatments tailored to individual clinical needs and patient preferences.
NICE recommends discussing all appropriate first-line options (as listed in Table 2) with the person, supporting shared decision-making. The treatment plan should balance clinical effectiveness, personal preference, and the potential burden or intrusiveness of each therapy.
Importantly, patients retain the right to decline treatment, and their choices should be respected throughout the decision-making process.
The table below summarises the first-line treatment options for a new episode of more severe depression.
| Treatment Type |
Delivery & Core Concepts |
| 🔷 Combination Therapy (CBT + Antidepressant) |
Combines regular CBT sessions with antidepressant medication.
Medication supports initial phase; CBT adds long-term coping strategies.
Risk of side effects and withdrawal from antidepressants.
|
| 🧠 Individual CBT |
16+ structured sessions focused on changing thoughts, beliefs, behaviours.
Good for people recognising unhelpful patterns.
Homework needed. Avoids medication side effects.
|
| 🏃 Individual Behavioural Activation (BA) |
12–16 sessions linking activities to mood improvements.
Focuses on action, not thoughts.
Helpful for inactivity or social withdrawal. Needs homework commitment.
|
| 💊 Antidepressant Medication |
SSRIs preferred first-line; SNRIs/others based on history.
Benefits seen in ~4 weeks. Requires ongoing review.
Risk of side effects, withdrawal difficulty.
|
| 🛠️ Individual Problem-Solving Therapy |
6–12 sessions solving current problems step-by-step.
Structured and goal-focused.
Good for immediate life difficulties.
|
| 🎧 Counselling |
12–16 sessions using emotional exploration.
Focus on emotional meaning and coping.
Suitable for psychosocial, relationship, employment stressors.
|
| 🔎 Short-Term Psychodynamic Psychotherapy (STPP) |
16+ sessions exploring emotional conflicts and relationship patterns.
Insight-focused but may initially increase distress.
Helpful for deeper relational issues.
|
| 🤝 Interpersonal Psychotherapy (IPT) |
16 sessions focusing on improving interpersonal relationships and coping with loss/transitions.
Good for depression linked to relationship difficulties.
Requires willingness to discuss relationships.
|
| 📚 Guided Self-Help |
Structured CBT/BA materials with practitioner support.
6–8 sessions.
More suitable for mild-moderate depression; consider more therapist support first for severe depression.
|
| 🏋️ Group Exercise |
10+ week structured physical activity in groups.
Good for physical health and wellbeing.
May need adaptations if severe psychological or physical barriers.
|
↓
1.7 Behavioural Couples Therapy for Depression
- Consider for people with less severe or more severe depression where relationship issues contribute to depression, or partner involvement may aid recovery.
- Delivers structured therapy following behavioural principles.
- Typically involves 15–20 sessions over 5–6 months.
↓
1.8 Preventing Relapse
- Continue treatment (antidepressants or psychological therapy) after remission to reduce relapse risk — based on shared decision-making.
- Higher relapse risk if history includes: frequent episodes, residual symptoms, severe depression, unhelpful coping styles, chronic stressors.
- Discuss long-term antidepressant risks: side effects (e.g., bleeding, sexual dysfunction), withdrawal challenges.
- If stopping antidepressants, provide advice on safe tapering and encourage early help-seeking for symptom return.
- Relapse prevention options:
- Continue antidepressants (maintain dose unless side effects).
- Offer group CBT or MBCT if stopping antidepressants.
- Combination of medication and therapy if preferred.
- Psychological relapse prevention: 8 sessions (2–3 months) plus optional booster sessions over 12 months, focusing on relapse coping skills.
- Review treatment every 6 months if continuing antidepressants; reassess relapse risk if finishing psychological therapy.
1.9 Further-Line Treatment
If a person's depression does not respond to initial treatment — whether antidepressant medication, psychological therapy, or a combination of both — NICE recommends a structured, patient-centred approach to further management.
The first step is to explore possible reasons for non-response, including social, psychological, physical health, or adherence issues. Addressing these underlying factors is crucial before adjusting treatment.
If no clear barriers are found and the depression remains resistant despite adequate treatment trials, clinicians should review the diagnosis and consider alternative or comorbid conditions. Further treatment options can then be discussed through shared decision-making, with choices tailored to the person’s clinical needs and preferences.
| Step |
Key Concept |
| 🛠️ Step 1: Identify Barriers |
Check for factors like adherence issues, side effects, social/personal/environmental barriers, or comorbidities.
Address problems before changing treatment.
|
| 🔎 Step 2: Review Diagnosis |
If no response after addressing barriers, reassess diagnosis; consider comorbid or alternative conditions.
|
| 💬 Step 3: Reassure & Discuss Options |
Reassure that other treatments exist. Discuss past helpful treatments, preferences, and shared decision-making.
|
| 🔄 Step 4a: Limited Response to Psychological Therapy Alone |
Options: switch to another psychological therapy, add an SSRI, or switch to SSRI alone.
|
| 💊 Step 4b: Limited Response to Antidepressants Alone |
Options: add group exercise, switch to psychological therapy, increase antidepressant dose, switch antidepressants (same/different class), or combine medication and therapy.
|
| ⚡ Step 4c: Limited Response to Combination (Medication + Therapy) |
Options: switch therapy, switch/increase antidepressant, or add augmentation treatment.
|
| 🧬 Step 5: Augmentation Options |
If willing to accept higher side-effect risks:
- Add a second antidepressant (different class).
- Add second-generation antipsychotic (aripiprazole, olanzapine, quetiapine, risperidone).
- Add lithium, lamotrigine, or triiodothyronine (specialist input needed).
- Consider ECT if indicated.
⚠️ Be cautious of dangerous combinations (e.g., SSRI/SNRI + MAOI).
|
| 📈 Step 6: NICE-Specific Recommendations |
- Vortioxetine recommended if no/little response to 2 previous antidepressants.
- Specialist consultation recommended for complex augmentation or switching strategies.
|
1.10 Chronic Depressive Symptoms
Chronic depressive symptoms are often under-recognised in primary care. Many individuals with longstanding low mood may not have previously sought help, and they might not even identify their symptoms as depression.
It is important for clinicians to proactively initiate conversations about mood, functioning, and emotional wellbeing with these patients. Gentle, structured discussions can open the door to diagnosis and access to appropriate support and treatment.
This section highlights the key role of healthcare practitioners in identifying chronic depression and supporting patients towards recovery.
| Area |
Key Concepts |
| 💬 Initial Treatment Options |
- Offer CBT focused on chronic symptoms.
- Consider SSRIs, SNRIs, TCAs (caution: TCA overdose risk).
- Combination therapy (CBT + SSRI or TCA) is another option.
- Shared decision-making essential.
|
| 🧠 Psychological Focus |
- Address maintaining behaviours: avoidance, rumination, interpersonal difficulties.
|
| 🔄 Medication Adjustments |
- If SSRI not tolerated, switch to another SSRI.
- If no response to SSRIs/SNRIs, specialist advice for alternatives:
TCAs, moclobemide, irreversible MAOIs (e.g., phenelzine), or low-dose amisulpride.
|
| 🤝 Social and Vocational Support |
- Consider befriending programmes (weekly volunteer contact for 2–6 months).
- Recommend rehabilitation if social withdrawal or loss of work occurred.
|
| 🏥 Referral to Specialist Services |
- If no or limited response despite appropriate treatments, refer to specialist mental health services for further management.
|
| 🛑 Long-Term Antidepressant Review |
- For people on long-term antidepressants with poor response:
Review benefit, consider stopping medication, explore reasons for non-response, and plan alternative support.
|
1.11 Depression in People with a Diagnosis of Personality Disorder
People with a diagnosis of personality disorder are at increased risk of developing depression.
It is crucial that treatment for depression is not withheld due to the presence of a coexisting personality disorder.
These individuals should be offered the same range of evidence-based interventions for depression, based on their clinical needs and preferences, as outlined in this guideline.
Management should focus on shared decision-making, continuity of care, and close monitoring to support positive outcomes.
| Area |
Key Concepts |
| 💊 + 🧠 Combination Treatment |
- Combine antidepressant medication with psychological therapy (e.g., BA, CBT, IPT, or STPP).
- Help patients choose therapy type based on needs/preferences.
|
| 🔄 Treatment Delivery |
- Provide structured support in a multidisciplinary setting.
- Encourage ongoing engagement.
- Use mood charts or symptom checklists for monitoring.
- Extend treatment duration if needed (up to 1 year).
|
| 🏥 Specialist Referral |
- Consider referral to a specialist personality disorder service.
- Follow additional NICE guidance if borderline personality disorder is present.
|
1.12 Psychotic Depression
Psychotic depression is a severe form of depressive illness characterised by the presence of psychotic symptoms such as delusions or hallucinations, alongside depressive symptoms.
Management requires a combination of antidepressant and antipsychotic treatment, often delivered with specialist input.
Clinicians should be aware that, as of June 2022, the use of some antipsychotics in treating depression is considered off-label. Careful prescribing, shared decision-making, and adherence to NICE's safe prescribing principles are essential.
| Area |
Key Concepts |
| 🏥 Referral to Specialist Services |
- Refer all patients with psychotic depression to specialist mental health services.
- Ensure risk assessment, needs assessment, multidisciplinary care, and access to psychological therapies after acute symptoms improve.
|
| 💊 Combination Treatment |
- Offer antidepressant + antipsychotic combination (e.g., olanzapine or quetiapine).
- If patient declines antipsychotic, continue with antidepressant alone based on shared decision-making.
|
| 📈 Monitoring |
- Regularly monitor treatment response, especially unusual thoughts and hallucinations.
- Continue antipsychotic medication for several months after remission if tolerated; decisions about stopping should involve specialists.
|
| 🔍 Prescribing and Safety |
- Follow safe prescribing practices for antipsychotics.
- Consult NICE guidelines on psychosis and schizophrenia for additional monitoring guidance.
|
1.13 Electroconvulsive Therapy for Depression
Electroconvulsive therapy (ECT) remains an important treatment option for people with severe depression, particularly when a rapid response is critical, when other treatments have failed, or when a person specifically chooses ECT based on previous positive experience.
ECT should be considered carefully within specialist mental health settings, following thorough assessment and shared decision-making, ensuring the person's preferences, clinical needs, and past treatment history are fully taken into account.
| Area |
Key Concepts |
| 🧠 Informed Consent and Risk Discussion |
- Inform patients fully of ECT risks (anaesthetic, comorbidities, cognitive effects).
- Obtain valid, pressure-free consent; respect Mental Health Act provisions.
- Document all assessments and decisions.
|
| 🔄 Treatment Considerations |
- Only reattempt ECT after poor previous response if all options reviewed.
- Stop ECT if side effects outweigh benefits or remission achieved.
|
| 🏥 Service Standards |
- ECT clinics must be ECTAS-accredited.
- Trusts must ensure board-level monitoring of ECT services and outcome submissions.
|
| 📈 Post-ECT Care |
- After successful ECT, initiate/continue antidepressants or psychological therapy.
- Consider lithium augmentation if needed to prevent relapse.
|
Specialist care
| Area |
Key Concepts |
| 🏥 Referral to Specialist Care |
- Refer if depression severely impairs functioning AND:
➔ No benefit from previous treatments
➔ Plus either: multiple complicating social issues (e.g., unemployment) OR significant coexisting health conditions.
|
| 📝 Multidisciplinary Care Plan |
- Jointly developed with patient, GP, and other care providers.
- Includes:
➔ Defined roles/responsibilities
➔ 24-hour support contact details
➔ Crisis plan (triggers + management strategies)
➔ Regular reviews and updates
➔ Medication management plan (start, review, discontinue).
|
Crisis care, home treatment and inpatient care
| Area |
Key Concepts |
| 🚑 Crisis Resolution and Home Treatment (CRHT) |
- Consider CRHT for severe depression with high risk of:
➔ Suicide (especially living alone)
➔ Self-harm, harm to others, self-neglect
➔ Treatment complications (e.g., elderly with comorbidities).
- CRHT teams must:
➔ Monitor/manage risk routinely
➔ Implement and maintain treatment plans
➔ Set crisis plans before discharge.
|
| 🏥 Inpatient Care |
- Consider inpatient admission if CRHT cannot provide adequate support.
- Increase therapy intensity during inpatient stay.
- Ensure therapy continuation after discharge.
|
| 🔄 Early Discharge via CRHT |
- Use CRHT teams to support early discharge from inpatient care where possible.
|
Terms Used in This Guideline
This section defines key terms that are used in a specific way within this guideline.
For broader definitions of healthcare terminology, readers can also refer to the NICE glossary and the Think Local, Act Personal Care and Support Jargon Buster.
| Term |
Brief Definition |
| Acquired Cognitive Impairments |
Neurological disorders affecting learning, memory, communication, and problem-solving (e.g., dementia, brain injury). |
| Avoidance |
Behavioural coping that avoids addressing difficult thoughts, feelings, or activities. |
| Chronic Depressive Symptoms |
Persistent depressive symptoms lasting ≥2 years, with possible social and personal difficulties. |
| Collaborative Care |
Integrated case management between primary, secondary, and mental health services with shared goal-setting. |
| Depression |
As per ICD-11 or DSM-5: persistent low mood and associated symptoms impacting functioning. |
| Less Severe Depression |
Subthreshold or mild depression (PHQ-9 score <16). |
| Medication Management |
Advice on adhering to prescribed medication regimens. |
| More Severe Depression |
Moderate to severe depression (PHQ-9 score ≥16). |
| Personal and Social Functioning |
Ability to engage in daily living and social relationships. |
| Routine (Sessional) Outcome Monitoring |
Regular measurement of symptoms or functioning during treatment (e.g., sessional PHQ-9 use). |
| Rumination |
Prolonged negative thinking about oneself, symptoms, or life problems. |
| Stepped Care / Matched Care |
Systematic delivery of least intrusive treatments first, escalating if needed, matched to patient needs/preferences. |
| Treatment Manuals |
Evidence-based structured guides used in delivering psychological treatments. |
References : https://www.nice.org.uk/guidance/ng222/chapter/Recommendations#choice-of-treatments
