Doctors will be told not to offer antidepressants to those with mild illness and instead suggest options such as meditation, mindfulness and talking therapies.
The new NHS guidance comes after the number of pills prescribed for depression doubled over the last decade, with the condition soaring since the pandemic.
England already has one of the highest rates of antidepressant use in the world, with one in seven people estimated to be taking the pills.
The draft guidance from the National Institute for Health and Care Excellence (Nice) says patients with symptoms of mild depression should be free to choose from a “menu” of options. These include cognitive behavioural therapy, exercise, mindfulness, meditation, counselling and psychotherapy.
If patients express no preference, the first option offered should be a group class in group cognitive behavioural therapy, the guidance suggests.
The therapy focuses on trying to break a cycle of negative thoughts and beliefs.
The guidance also suggests that patients could be offered group behavioural activation, which aims to recognise negative patterns and focus on behaviours that are linked to improved mood.
GPs are urged not to offer antidepressants to those with mild or borderline depression.
The draft guideline, which is subject to consultation, states: “Do not routinely offer antidepressants as a first-line treatment, unless that is the person’s preference.”
Rise in use of antidepressants
Latest NHS data shows more than 79 million antidepressant drugs prescribed in England 2020-21 – up from 43 million in a decade.
In total, 7.87 million people in England were prescribed the drugs in 2020-21, NHS data show – one in seven people.
Last week, the Health Secretary warned that levels of depression had nearly doubled since the pandemic. Latest UK statistics show 17 per cent of adults suffering such symptoms, compared with 10 per cent before the first lockdown.
Dr Paul Chrisp, director of the centre for guidelines at Nice, said: “People with depression deserve and expect the best treatment from the NHS, which is why this guideline is urgently required.
“The Covid-19 pandemic has shown us the impact depression has had on the nation’s mental health. People with depression need these evidence-based guideline recommendations available to the NHS, without delay.”
Earlier this year, an independent review found a 10th of prescription medicines doled out by GPs are unnecessary, pushing the NHS drugs bill to more than £9 billion.
The review, led by Dr Keith Ridge, NHS chief pharmacist, said patients were routinely being harmed by a “culture” of overprescribing. Too often patients felt unable to question medics who did not look up from their keyboards, it said.
Last month, the Royal College of Psychiatrists warned that mental health referrals are forecast to rise by a third in the wake of the pandemic, resulting in an extra 1.8 million cases.
The NHS is already facing the biggest backlog of those waiting for such help in its history.
Currently, there are about 5.4 million referrals annually in England, a figure which is projected to rise to 7.2 million by 2023.
‘Depression is different for everyone’
The new Nice draft guideline is the first in 12 years to identify, treat and manage depression in adults.
Nice said the menu of treatment options should allow patients to pick the one which is right for them, as a result of “shared decision-making” with their medical practitioner.
For those with more severe depression, a similar range of treatment options should be offered, along with the option of antidepressant medication, the guidance says.
Nav Kapur, professor of psychiatry and population health at the University of Manchester and chairman of the guideline committee, said: “As a committee we have drawn up recommendations that we hope will have a real impact on people who are suffering from depression and their carers.
“In particular, we’ve emphasised the role of patient choice – suggesting that practitioners should offer people a choice of evidence-based treatments and understanding that not every treatment will suit every person.”
Doctors are also advised to discuss mental health waiting lists with patients and inform them of possible delays, as well as to provide advice to those who want to stop taking antidepressants – with warnings that withdrawal can take months.
Professor Martin Marshall, chairman of the Royal College of GPs, said: “Depression can affect different patients in different ways. Decisions about a treatment plan should be shared between patient and GP, as a result of a discussion about the risks and benefits and taking into consideration an individual’s circumstances and preferences – and this guideline should help facilitate that.
“However, access to some treatments are patchy across the country and it is vital that GPs have access to a wide variety of treatments for their patients with depression, so that they can benefit from them regardless of where they live.”
A Royal College of Psychiatrists spokesman said: “We support a range of treatment options being available for those suffering from depression, including psychological therapies and antidepressant medication depending on the severity of the symptoms.
“Depression is different for everyone, some people might experience mild symptoms for a limited time while others might become severely unwell for longer periods.”