In drafting the new guideline, NICE has assessed various treatment options and listed them in order of recommended use based on their clinical and cost effectiveness. While this ranks them (see panel), NICE says any could be used as the entry point first-line option for a new episode of depression.4
If the patient has a clear treatment preference or has experience of a previous treatment then that could inform the start of new therapy. The practitioner should generally support the patient preference, unless there are concerns about suitability for this episode of depression
If there is no preference, then the treatment at the top of the list would be recommended – group cognitive behavioural therapy (CBT) for those with less severe depression, or individual CBT plus antidepressant medication for those with more severe depression.