New depression treatment guideline ‘not fit for purpose’

An Essex expert on mental health is part of a coalition campaigning for a fundamental rethink of depression treatment guidelines in the UK.

Fourteen mental health organisations and six leading doctors say the latest draft guideline on adult depression by the National Institute for Health and Care Excellence (NICE) is not fit for purpose and could harm patients.

Responding to a public consultation, the group’s position paper calls for a full revision of the guideline, arguing the proposals are based on flawed research methods, are biased towards medical trials and ignore a large amount of research on patient experience.

The paper cited past and ongoing research by Dr Susan McPherson, Senior Lecturer in our School of Health and Social Care, who is a key member of the coalition.

Dr McPherson said: “In the UK, national guidelines have a direct impact on what help people get when they experience depression. Publication of this guideline will lead to services being reshaped to reflect its recommendations. Patients will continue to have very limited choices of treatment.

“For example, CBT [cognitive-based therapy] is now routinely offered to patients in the UK. But there are also many other types of therapy that could help and are not being offered. Different people find different types of therapy helpful. The problem is that NICE approach the guideline with the assumption that there must be one best form of treatment that will benefit the majority. As a result, everyone has to try that treatment and if it doesn’t work, they’re rarely offered anything else.”

NICE released the first draft of the revised guideline for consultation in July 2017 and Dr McPherson wrote a University response. She discussed it with Dr Felicitas Rost at the Society for Psychotherapy Research and they teamed up with several organisations to express their shared concerns. 

The issue was taken up by Liberal Democrat MP Norman Lamb and others, and in February 2018 a number of MPs signed a cross party letter to NICE, asking it to respond to the stakeholders’ call for a second consultation. After a meeting with stakeholders in April, NICE agreed.

Dr McPherson said: “We were pleased when NICE announced the second consultation as we understand this is quite a rare occurrence. We thought this might mean our concerns had been listened to. However, when we looked at the second draft we were disappointed to find that only cosmetic changes had been made. Our most serious methodological concerns had been brushed aside.”

The second consultation ended in June and individual organisations have submitted their own responses in addition to the group statement which had, by the closing date, gathered significant signatories including the Royal College of Psychiatrists and the British Psychological Society. Dr McPherson wrote a response for the University.

“It appears that the NICE guideline committee for depression is still not listening to patient and professional concerns about their approach,” Dr McPherson said. “We hope they will realise the weight of that opinion demands that they postpone publication and work seriously through the issues raised.”