The Scottish Intercollegiate Guidelines Network (SIGN) was formed in 1993 with the objective " ... to improve the quality of health care for patients in Scotland by reducing variation in practice and outcome, through the development and dissemination of national clinical guidelines containing recommendations for effective practice based on current evidence."  It has a broad membership including " ...  all the medical specialties, nursing, pharmacy, dentistry, professions allied to medicine, patients, health service managers, social services, and researchers."  SIGN has "a programme of 113 evidence-based clinical guidelines - published, in development, or under review - covering a wide range of topics. Many of the SIGN guidelines relate to the NHS priority areas of cancer, cardiovascular disease, and mental health."

On Wednesday - a couple of days ago - the draft of their guideline on "Non-pharmacological management of depression in adults." was presented at a full day open seminar.  I believe SIGN had more applications to come to this seminar than for any of their previous draft guideline presentations.  You can access a PDF of the 34 page document they provided by clicking here and go to a webcast of the meeting here.  If you want to send in your comments, you'll need to do so by the 27^th of this month. 

SIGN seems to be a very good organization.  It's guidelines are put together by health professionals and others volunteering to give a huge amount of their time, most of it unpaid.  Some years ago I was involved in a SIGN group developing recommendations for managing anxiety disorders.  Sadly the guideline didn't finally make the light of day, but we did get to this draft document presentation phase.  A major reason for the current depression guideline being tackled was representation from Ruth Lang, Information and Support Officer at the charity Depression Alliance Scotland (DAS) - great congratulations to her for taking this initiative.  Initially Dr Gerry McPartlin at DAS was approached to chair the guideline development group.  He was unable to take this on and suggested I should be approached instead - Gerry and I were colleagues on the DAS Clinical Advisory Group.  For various good reasons, Mike Henderson (a consultant clinical psychologist in NHS Borders) ended up being asked to take on this role and a successful and impressive job he seems to have done.

When I thought I might possibly be chairing the guideline group early last year, I put together an initial mind-map PDF.  Looking back at this document, I'm struck by two points.  One was my sense that advice on non-pharmacological management of depression involving adolescents and pregnant women would be particularly valuable (pharmacological treatments can be very tricky for these groups).  Sadly - presumably because of the extra time that would be involved - the guideline group decided not to look at these populations.  I think this is a great pity.  The other point I noted was a concern that guidelines are in danger of emerging after huge amounts of work, only to have very little effect on actual practice.  There is evidence that following guidelines for treatment of depression can improve outcomes (Hepner, Rowe et al. 2007).  However there is also evidence that simply developing a guideline is largely ineffective at changing practice (Gilbody, Whitty et al. 2003). Guideline implementation is as important as guideline development.  The development group deserve our congratulations and thanks for the impressive job they've done.  Let's hope the challenge of implementation is responded too as effectively as development has been.

Gilbody, S., P. Whitty, et al. (2003). "Educational and Organizational Interventions to Improve the Management of Depression in Primary Care: A Systematic Review." JAMA 289(23): 3145-3151.  [Abstract/Free Full Text]
Hepner, K. A., M. Rowe, et al. (2007). "The effect of adherence to practice guidelines on depression outcomes." Ann Intern Med 147(5): 320-9.  [Abstract/Free Full PDF]