BACP’s Summary of main concerns
1. NICE should move from an over-reliance on data collected through randomised controlled trials (RCTs) and ensure that other types of evidence, including data from real world practice, are recognised and valued in the production of recommendations.
2. NICE should conduct a proper analysis of one and two-year follow-up data from trials and priorities treatment recommendations, made on the basis of this data over and above recommendations, which are made on the basis of short-term outcomes (less than one year).
3. A full systematic review of primary studies of service user experience is required, employing formal methodology for qualitative synthesis; and findings from such a review must be incorporated into the broader approach to quantitative review and treatment recommendations rather than left as a stand-alone section.
4. Trial where the majority of population is clinically complex, chronic or treatment resistant need to be grouped together as persistent depression for the purposes of review, following the European Psychiatric Association.
5. The guideline review must look at the amount of clinical effect (e.g. partial recovery) from a severe baseline point and not ignore treatment effects because clients do not fully recover by the end of treatment. Moreover, categorisations of depression severity must be based on validated tools, not un-validated non-transparent functions of them.
6. Findings from indirect or mixed comparisons using Network Meta-Analysis (NMA) should only be used to supplement evidence derived from direct comparisons. NICE must re-analyse the data using standard meta-analyses and should NMA be used to supplement the findings, a validated and reliable model for doing so should be employed.
7. NICE must run a re-analysis of studies using quality of life and/or functions outcomes, where these are available, and prioritise recommendations based on these measures, given that these are the measures of greatest priority to service users.