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NICE urged not to publish its draft Guideline for Depression in Adults

Publication date: June 19, 2018

UKCP has urged NICE not to publish its draft Guideline for Depression in Adults, after the unprecedented second consultation on it closed last week.

Responding both individually and together with a diverse umbrella group of mental health organisations, we argued that NICE has used a flawed scientific model in developing this Guideline, which would strip away potentially life-saving patient choice for the millions of people in this country experiencing depression.

Commenting after the consultation closed, UKCP Chief Executive Prof Sarah Niblock said:

‘We urge NICE not to publish this guideline, because it fails to meet the high scientific standards essential for ensuring public safety.

‘With a least a quarter of the UK adult population suffering depression at any given moment, we must get this right or face a worsening of a crisis situation.’

As well as producing our own response, we also worked closely with a range of organisations across the mental health sector, including BACP, BPS, RCPsych and Mind, to produce a joint response to the consultation.

Both responses focused on the flawed methodology NICE used to produce the guideline and the risks posed by its implementation, highlighting:

  • The threat to patient choice. Despite acknowledging the importance of offering a choice of treatments, the draft Guideline proposes Cognitive Behavioural Therapy (CBT) or medication as the first-line treatment for all forms of depression, denying adults with depression the opportunity to benefit from alternative talking therapy treatments.
  • NICE’s over-reliance on Randomised Controlled Trials (RCTs). RCTs were the only form of evidence accepted by the Guideline Committee, meaning that a huge number of relevant studies were excluded from the evidence-base, as well the enormous IAPT dataset containing hundreds of thousands of real-world outcomes.
  •  The flawed method for measuring treatment effectiveness. The methods used in the production of the Guideline ignore the severity of depression at the start of the treatment.
  •  The failure to meet parity of esteem by not including long-term follow-ups. NICE Guidelines for long-term physical health issues require 12-24 month follow-up for evidence to be accepted.
  • The extremely narrow focus on symptom outcomes. The draft Guideline fails to take into account wider elements of service user experience such as quality of life, relationships and ability to participate in work, education or society.
  • The current draft guideline is completely out of step with US and European guideline methodologies. The Guidance Development Group has created its own, in our view, flawed method for categorising depression by longevity and severity.

In light of the raft of concerns about both the methodology behind the Guideline and the risks posed to the public, both of our consultation responses urged NICE to postpone its publication.

Prof Niblock said: ‘We, along with similar expert bodies, note significant flaws in the science behind this draft, and ask that NICE’s executive postpone publication until a proper revision can be undertaken.

‘Any guideline on such an urgent and important issue affecting millions of individuals, as well as their loved ones and colleagues, must meet the high scientific standard expected of NICE, which is otherwise seen as a world leader in guideline development.’

You can download and read the UKCP second consultation response here.

You can download and read the collaborative second consultation response here.