With a depression diagnosis, the 2009 NICE guidelines recommended a stepped-care approach, with the least intrusive, most effective intervention provided first. If a patient was not benefiting from the intervention initially offered, or declined an intervention, they should have been offered an appropriate intervention from the next step.3
The draft 2022 NICE guideline changes how this is expressed, proposing that depression should be considered as either:4
·       “less severe” which includes the traditional categories of “subthreshold symptoms” and “mild” depression
·       “more severe” which includes the traditional categories of “moderate” and “severe” depression.
It then proposes there should be a discussion with the patient to explore:
·       what, if anything they think may be contributing to the development of their depression
·       whether they have ideas or preferences about starting treatment, and what their preferred options might be
·       what they would expect to gain from treatment.
This discussion might involve family members, carers or supporters if the patient would like them to be involved. The discussion around treatment preferences should include information about potential benefits and harms, any waiting times for treatments and expected outcomes.
This information may then be used to come to a shared decision on the preferred treatment option.