The UK draft NICE guideline on depression in adults was sent out for stakeholder consultation between July and September 2017. The final guideline publication date currently remains ‘to be confirmed’. This paper sets out key concerns with the methodology employed in the guideline and its impact on recommendations for psychodynamic psychotherapies for complex and persistent depression. The draft largely ignored the subjective experiences and voices of service users, carers and members of the public, using out of date limited evidence of service user and carer experiences. The guideline fails to incorporate what limited qualitative evidence it reviewed into any treatment recommendations. The Guideline Committee created its own method for categorising depression by longevity, severity and complexity. This has resulted in erroneous and unhelpful classifications of research studies under groupings which do not match clinical and service user experiences or US and European approaches, rendering analyses and conclusions unreliable. We also outline instances of incorrect classification of psychodynamic treatments (such as inclusion of non bona fide treatments or exclusion of relevant bona fide treatment studies) which enables the omission of a recommendation for psychodynamic psychotherapy for complex and persistent depression. Depression is often a long-term condition or can become so if immediate care is inadequate; yet the draft recommendations are all made on the basis of short-term outcome data (with often less than eight weeks between baseline and outcome). NICE guidelines for long-term physical conditions would treat this evidence as inadequate. Finally, the draft guideline used the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system of assessing methodological quality in such a way as to produce a systematic bias in favour of drug trials, selectively omitting trial data with long-term follow-up points and those which used non-symptom outcomes. Herein, we consider the increasingly evident limitations of the paradigm NICE works within for ensuring patient choice and equity of access to a wide range of therapies.

中文翻译：

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NICE审查方法论的认识论缺陷及其对复杂和持续性抑郁症的心理动力疗法的建议的影响

英国关于成年人抑郁症的NICE指南草案已于2017年7月至9月之间发送给利益相关方咨询。目前，该指南的最终发布日期仍有待“确认”。本文提出了与指南中使用的方法有关的主要问题，以及该方法对复杂和持续性抑郁症的心理动力疗法的建议的影响。该草案使用了过时的服务使用者和看护者经验的有限证据，在很大程度上忽略了服务使用者，看护者和公众的主观体验和声音。该指南未能将其所审查的有限的定性证据纳入任何治疗建议中。指导委员会创建了自己的方法，根据寿命，严重程度和复杂程度对抑郁症进行分类。这导致对研究的错误分类和无用的分类，这些分类与临床和服务用户的体验或美国和欧洲的方法不符，从而使分析和结论不可靠。我们还概述了心理动力疗法分类错误的情况（例如，纳入非善意疗法或排除了相关的善意疗法研究），从而可以省略针对复杂性和持续性抑郁症的心理动力心理疗法建议。抑郁症通常是长期病，如果不能及时护理，抑郁症可能会变得很长。然而，建议草案都是根据短期结果数据提出的（基线和结果之间通常少于八周）。NICE关于长期身体状况的指导方针认为该证据不足。最后，指南草案使用了对方法学质量进行评估的“建议，评估，发展和评估分级”（GRADE）系统，从而产生了有利于药物试验的系统性偏见，选择性地省略了长期随访的试验数据。上升点和使用非症状结果的上升点。在此，我们认为NICE范式在确保患者选择和获得广泛疗法的公平性方面的局限性日益明显。有选择地省略具有长期随访点的试验数据和采用无症状结果的试验数据。在此，我们认为NICE范式在确保患者选择和获得广泛疗法的公平性方面的局限性日益明显。有选择地省略具有长期随访点的试验数据和采用无症状结果的试验数据。在此，我们认为NICE范式在确保患者选择和获得广泛疗法的公平性方面的局限性日益明显。