February 2005

Best treatment for mild or moderate depression unclear

Editorial: NICE guidelines for the management of depression BMJ Volume 330, pp 267-8

Guidelines for the management of mild or moderate depression are unclear because firm evidence is lacking, claim doctors in this week's BMJ.

The National Institute for Clinical Excellence (NICE) provides clear guidance on the treatment of moderate to severe depression, but what is less clear is the appropriate treatment for mild to moderate depression, write Gene Feder and colleagues.

They say that the study on which the guidelines are based identifies evidence supporting problem solving therapies and counselling, but evidence on other interventions is weak or absent.

Although these shortcomings are acknowledged, the guidelines offer limited advice on how to determine whether or not a particular patient may benefit from treatment, they add.

They suggest that we need a better understanding of the interaction that occurs when individuals seek medical help for an emotional problem. "This medicalisation of unhappiness would benefit from sociological as well as clinical research," they conclude.