We are grateful for the opportunity to respond to the editorial ‘Should antidepressants be prescribed simply if it is the patient’s preference?’,1 which raises concerns about recommendation 1.5.3 of the National Institute for Health and Care Excellence (NICE) guideline on depression in adults.2 We welcome this opportunity to clarify the guideline’s intent.
NG222 does not recommend antidepressants as a routine or first-line treatment for less severe depression. It follows a matched-care model, prioritising the least intrusive and least resource-intensive interventions. First-line options include guided self-help, group behavioural activation, group cognitive behavioural therapy, and structured physical activity programmes. Antidepressants may be offered only if this is the person’s preference, following discussion of potential benefits, risks, and alternative treatments.
Shared decision making is a core principle of NG222 and aligns with the NICE guideline on shared decision making,3 ensuring treatment choices reflect both evidence and individual values. However, to further improve clarity in this regard, recommendation 1.5.3 will be revised to:
‘1.5.3 Do not routinely offer antidepressant medication as first-line treatment for less severe depression. Only offer it if that is the person’s informed preference.’
This minor amendment confirms that antidepressants are one of several evidence-based options within a shared decision-making framework. The guideline also includes safeguards to support appropriate prescribing, including early review of treatment effectiveness and ensuring access to non-drug interventions.
In conclusion, NG222 promotes a balanced, evidence-informed approach that prioritises non-pharmacological treatments, embeds shared decision making, and ensures antidepressants are used appropriately and in line with informed patient preference. Our planned revision of recommendation 1.5.3 further clarifies this approach for clinicians and patients alike.
- © British Journal of General Practice 2025
