1 Recommendations
1.1
Two digitally enabled therapies can be used as treatment options for adults with depression while further evidence is generated on their clinical and cost effectiveness. The therapies should be used with support from a trained practitioner or therapist in NHS Talking Therapies for anxiety and depression services. These technologies can be used once they have Digital Technology Assessment Criteria (DTAC) approval and an NHS Talking Therapies for anxiety and depression digitally enabled therapies assessment from NHS England. The technologies are:
1.2
Further evidence should be generated on:
-
rates of recovery
-
rates of reliable recovery
-
rates of reliable improvement
-
rates of reliable deterioration
-
rates and reasons for stopping treatment
-
rates of relapse
-
adverse effects and stepping up of care
-
patient experience
-
health-related quality of life
-
resource use during and after treatment, including the average number of treatment sessions and level of guidance provided (defined by healthcare professional grade and time)
-
baseline data, including the demographics and symptom severity of the people using the technology, and their risk classification.
Find out more in the evidence generation section of this guidance.
1.3
The following technologies should only be used as part of a research study that has been approved by an ethics committee, once they have appropriate regulatory approval:
Potential benefits of early value assessment
-
Access: Digitally enabled therapies offer another treatment option for adults with depression. People using them will be supported by an appropriately trained NHS Talking Therapies for anxiety and depression (formerly Improving Access to Psychological Therapies, or IAPT) practitioner or therapist, including psychological wellbeing practitioners. The technologies will particularly benefit anyone who needs more flexible access to treatment or who prefers digitally enabled therapy to face-to-face therapy.
-
Clinical benefit: The clinical evidence suggests that digitally enabled therapies may reduce symptoms of depression. They may help people better manage their symptoms and their treatment choices, which could increase their autonomy and empowerment.
-
Resources: Digitally enabled therapies may need less practitioner or therapist time for delivery than standard care psychological interventions in NHS Talking Therapies for anxiety and depression services. This could free up resources that could be allocated elsewhere in the services to increase access or reduce waiting times. There is preliminary evidence that suggests digitally enabled therapies may be cost effective compared with standard care.
Managing the risk of early value assessment
-
Clinical assessment: In NHS Talking Therapies for anxiety and depression services, digitally enabled therapies would be offered after assessment (which includes a risk assessment).
-
Clinical support: Digitally enabled therapies in NHS Talking Therapies for anxiety and depression services must be delivered with practitioner or therapist support, including monitoring and managing the safety of patients and their progress. This means that if the treatment is not working and symptoms worsen, it can be identified quickly.
-
Individual choice: Digitally enabled therapies can be offered as a treatment option for adults with depression. Some people may choose not to use digitally enabled therapies and may prefer another treatment option such as face-to-face therapy. Everyone has the right to make informed decisions about their care.
-
Equality: Digitally enabled therapies may not be accessible to everyone. Adults with limited access to equipment or to an internet connection, or who are less comfortable or skilled at using digital technologies, are less likely to benefit and may prefer another treatment option.
-
Costs: Results from the early economic analysis suggest that the technologies could be cost effective based on current prices and evidence. This guidance will be reviewed within 4 years and the recommendations may change. Take this into account when negotiating the length of contracts and licence costs.
-
Care pathway: This guidance focuses on using digitally enabled therapies for treating depression in adults using NHS Talking Therapies for anxiety and depression. Digital therapies may be used elsewhere in the NHS care pathway, but this is outside the scope of this assessment.
The evidence generation plan gives further information on the prioritised evidence gaps and outcomes, ongoing studies and potential real-world data sources. It includes how the evidence gaps could be resolved through real-world evidence studies.