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NICE ignored in face of CBT access crisis

NICE guidance on depression is having absolutely no impact on GP practice because the psychological therapies it recommends are not available.

New figures reveal that the institute's December 2004 guidance has failed to persuade GPs to use fewer antidepressants for mild depression.

GPs attacked the guidelines as 'completely unrealistic' because of 'woefully inadequate' access to the institute's first-line treatments of choice ­ such as cognitive behaviour therapy and counselling.

The new figures, compiled by the company CompuFile, came after Pulse last week launched a major survey of GP access to depression services.

In December 2005 there were 29,858 new prescriptions for antidepressants to treat adults with mild depression, slightly up on the 27,842 scripts in December 2004, the month of the NICE guidance. SSRI scripts also showed a slight rise.

NICE reiterated: 'The evidence clearly shows that psychological treatments are more clinically and cost effective than drug treatments for mild depression.'

It said strategic health authorities and the Healthcare Commission would be monitoring uptake of its guidance.

But Dr Chaand Nagpaul, a member of the NICE guideline review panel on depression and a GP in Stanmore, Middlesex, said the Government had a responsibility to understand why the guidance was not being implemented.

Dr Nagpaul said: 'The biggest limit in implementation of NICE guidelines is the patent lack of availability of psychological therapy. CBT provision is woefully inadequate and in most PCTs runs into several months' wait. As a result many GPs will resort to prescribing antidepressant medication.'

Dr Simon Clay, a GP in Erdington, Birmingham, said: 'We have no direct access to CBT. It's completely unrealistic advice, so we are forced to use antidepressants first-line in most cases.'

SSRI use for mild depression in under-18s fell from 651 scripts in December 2004 to 251 a year later, refuting recent claims by MPs that GPs continue to overuse the drugs in children.

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