Guidance
This guideline covers identifying, treating and managing depression in people aged 18 and over. It recommends treatments for first episodes of depression and further-line treatments, and provides advice on preventing relapse, and managing chronic depression, psychotic depression and depression with a coexisting diagnosis of personality disorder.
NICE has also produced a guideline on depression in adults with a chronic physical health problem.
Last reviewed: 19 September 2024
We added links to relevant technology appraisal guidance in the sections on further-line treatment and treatment-resistant depression. This is to provide easy access to relevant guidance at the right point in the guideline only and is not a change in practice.
In May 2024, we simplified the guideline by removing recommendations on general principles of care that are covered in other NICE guidelines (for example, the NICE guideline on service user experience in adult mental health). This is a presentational change only, and no changes to practice are intended.
This guideline updates and replaces NICE guideline CG90 (October 2009).
Next review: This guidance will be reviewed if there is new evidence that is likely to change the recommendations.
Recommendations
This guideline includes recommendations on:
- principles of care
- recognition and assessment
- choice and delivery of treatments
- treatment for a new episode of less severe depression
- treatment for a new episode of more severe depression
- behavioural couples therapy
- preventing relapse
- further-line treatment
- chronic depressive symptoms
- depression in people with a diagnosis of personality disorder
- psychotic depression
- electroconvulsive therapy, transcranial magnetic stimulation and treatment-resistant depression
- access, coordination and delivery of care.
See visual summaries on the recommendations for:
- discussing first-line treatments for less severe depression
- discussing first-line treatments for more severe depression
- preventing relapse
- further-line treatment
- treatment options for chronic depression, depression with personality disorder or psychotic depression
- the matched care model
Who is it for?
- Healthcare professionals
- Other professionals who have direct contact with, or provide health and other public services for, people with depression
- Commissioners and providers of services for people with depression
- People with depression, their families and carers
Guideline development process
How we develop NICE guidelines
This guideline was previously called depression in adults: recognition and management.
Your responsibility
The recommendations in this guideline represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, professionals and practitioners are expected to take this guideline fully into account, alongside the individual needs, preferences and values of their patients or the people using their service. It is not mandatory to apply the recommendations, and the guideline does not override the responsibility to make decisions appropriate to the circumstances of the individual, in consultation with them and their families and carers or guardian.
All problems (adverse events) related to a medicine or medical device used for treatment or in a procedure should be reported to the Medicines and Healthcare products Regulatory Agency using the Yellow Card Scheme.
Local commissioners and providers of healthcare have a responsibility to enable the guideline to be applied when individual professionals and people using services wish to use it. They should do so in the context of local and national priorities for funding and developing services, and in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities. Nothing in this guideline should be interpreted in a way that would be inconsistent with complying with those duties.
Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.