Management of common mental disorders in primary care

This research focuses on the clinical and cost-effectiveness of interventions for individuals with depression and anxiety in primary care.

There are a number of strands to this work. We have an interest in the clinical and cost-effectiveness of interventions for individuals whose depression has not responded to treatment with antidepressants (MIR and CoBalT). We are applying new technologies to increase the efficiency of, and widen access to, cognitive behavioural therapy (CBT) and have developed an integrated model of CBT using online materials and live therapists online (INTERACT). A multi-centre trial began in 2020. As part of our work within the NIHR Bristol Biomedical Research Centre (BRC), we are exploring ways of translating findings from basic cognitive science to help us understand the mechanisms underlying psychological interventions. We are also undertaking research focussed on the identification, diagnosis and management of anxiety disorders in primary care.

Selected Publications

Bansal, N., Hudda, M., Payne, R. A., Smith, D. J., Kessler, D. S. & Wiles, N. J., Antidepressant use and risk of adverse outcomes: population-based cohort study. Sep 2022, In: BJPsych Open. 8, 5, p. 1-9 9 p., e164.

Archer C, MacNeill S, Mars B, Turner K, Kessler D, Wiles N. The rise in prescribing for anxiety in UK primary care between 2003 and 2018: a population-based cohort study using CPRD. British Journal of General Practice (2022) 72 (720) e511-e518

Lewis G, Marston L, Duffy L, Freemantle N, Gilbody S, Hunter R, Kendrick T, Kessler D, Mangin D, King M, Lanham P, Moore M, Nazareth I, Wiles N, Bacon F, Bird M, Brabyn S, Burns A, Clarke CS, Hunt A, Pervin J, Lewis G. Maintenance or discontinuation of antidepressants in primary care. New England Journal of Medicine (2021) 385(14): 1257-1267

Archer C, Turner K, Kessler D, Mars B, Wiles N. Trends in the recording of anxiety in UK primary care: a multi-method approach. Social Psychiatry and Psychiatric Epidemiology (2021). https://doi.org/10.1007/s00127-021-02131-8

Archer C, Kessler D, Wiles N, Turner K. GPs’ and patients’ views on the value of diagnosing anxiety disorders in primary care: a qualitative interview study. British Journal of General Practice (2021) DOI: https://doi.org/10.3399/BJGP.2020.0959
Stawarz K, Preist C, Tallon D, Thomas L, Turner K, Wiles N, Kessler D, Shafran R, Coyle D. Integrating the digital and the traditional to deliver therapy for depression: lessons from a pragmatic study. CHI 2020: Proceedings of the 2020 CHI Conference on Human Factors in Computing Systems April 2020 Pages 1–14 https://doi.org/10.1145/3313831.3376510

Current projects

Wiles NJ, Kessler D, Turner K, Peters TJ, MacNeill S, Zammit S, Archer C, Tallon D, Hammerton G, Garfield K, Lewis G, Walters K, Robinson O, Huys Q, Lane JA, Dunn B, Payne R, Hendy G. Funder: NIHR Efficacy and Mechanism Evaluation (2025 to 2029) A randomised controlled trial evaluating the efficacy and mechanisms of eye movement desensitisation and reprocessing therapy (EMDR) compared with treatment as usual for adults with depression in primary care.

Archer C, Turner K, Ting L, Wiles N, Kessler D. Primary care practitioners’ and patients’ views on the benefits and challenges of remote consulting for anxiety and depression in primary care. NIHR School for Primary Care Research. 2022-2023. This study will inform how and when remote consultations should be conducted for patients discussing mental health problems.

Lewis G, Wiles N, Kessler D, Chew-Graham C, Freemantle N, Marston L, Roiser J, Robinson O, Hunter R, Lewis G, Duffy L, Walters K, Taylor D, Chipp B. Pregabalin for treatment resistant generalized anxiety disorder. NIHR Health Technology Assessment Programme. 2022 – 2026. This multi-centre trial is examining the clinical and cost-effectiveness of pregabalin as an adjunct to antidepressants for patients who have not responded to antidepressant treatment.

Russell A, Langdon P, Dagnan D, Wiles N, Cooper K, Kessler D, Horwood J, Thorn J, Ensum I, Ingham B, Rai D, Metcalfe C. Guided self-help for depression in adults with autism spectrum disorders. NIHR Health Technology Assessment Programme. 2021 – 2024. This multi-centre trial is evaluating the clinical and cost-effectiveness of a low-intensity guided self-help intervention for depression in adults with autism.

Browning M, Geddes J, Watson S, Kessler D, Evans J, Lewis G, Simon J et al A randomised placebo-controlled trial evaluating the efficacy and mechanism of pramipexole as add-on treatment for people with treatment resistant depression. NIHR Efficacy and Mechanism Evaluation Programme (16/127/17) 2020-2023. This study will compare the effects of pramipexole with placebo when added to current antidepressant medication for people with TRD

Wiles N, Kessler D, Welton N, Wevill C, Coyle D, Turner K, Churchill R, Parrott S, Williams C, Lewis G, Nazareth I, Shafran R, Gilbody S, Peters T, Macleod U, Lanham P. Integrated therapist and online CBT for depression in primary care. NIHR Programme Grant for Applied Research. 2016 – 2024. This programme of work is developing and evaluating a novel approach to delivering cognitive behavioural therapy that integrates online CBT materials and input from an accredited therapist.

Penton-Voak I, Fallon S-J, Kessler D, Wiles N, Munafò M. fMRI investigation of the neural mechanisms of Emotional Cognitive Bias Modification as an adjunct therapy to SSRIs in depression. MRC Experimental Challenge Grant. 2019 – 2022. This study is investigating whether a psychological therapy that improves the way we see emotion in others could improve the efficacy of antidepressants.

Professor Nicola Wiles,

Professor David Kessler

Fiona Reid

Tallon D, Thomas L, Brabyn S, Ching BCF, Hahn JS, Logan M, Burrage A, Fox F, Gilbody S, Lanham P, Lewis G, Li J, MacNeill S, Nazareth I, Parrott S, Peters TJ, Shafran R, Turner K, Williams C, Kessler D, Wiles N. Integrated therapist and online CBT for depression in primary care (INTERACT): a study protocol for a multi-centre randomised controlled trial. Trials (2023) 24: 421 doi: 10.1186/s13063-023-07396-9.

Bansal N, Malpass A, Chew-Graham C, Dowrick C, Wiles N, Kessler D, Cohen R. Understanding ethnic inequities in pathways to mental health services: A meta-ethnography of perceptions and experiences of people from ethnic minority groups. NIHR Research for Patient Benefit (RfPB) 2020 – 2021.

Bansal N, Kessler D, Wiles N, Payne R. Antidepressant use and risk of morbidity and mortality: a population-based cohort study. NIHR School for Primary Care Research. 2018-2021.

Lewis G, Nazareth I, King M, Kessler D, Gilbody S, Freemantle N, Hunter R, Kendrick A, Moore M, Wiles N. Antidepressants to prevent relapse in depression. NIHR Health Technology Assessment Programme.. 2016-2020

Barnes M, Kessler D, Wiles N. Exploring barriers and facilitators to identifying anxiety disorders in primary care. NIHR School for Primary Care Research. 2017-2019.

Lewis G, Araya R, Churchill R, Hollingworth W, Kessler D, Peters TJ, Welton N, Wiles NJ, Ades T, Malpass A, Dowrick C, Robinson J, Kendrick T, Gilbody S, Croudace T. What are the indications for prescribing antidepressants that will lead to clinical benefit? (PANDA). NIHR Programme Grant for Applied Research. 2012 – 2018.

Kessler D, Hollingworth W, Lewis G, Davies S, Wiles NJ, Peters TJ, Chew-Graham C, Gilbody S, Anderson I, Macleod U, Campbell J, Dickens C. A double-blind placebo controlled randomised trial of the addition of the antidepressant mirtazapine for patients with depression in primary care who have not responded to treatment with a selective serotonin reuptake inhibitor (MIR). NIHR Health Technology Assessment Programme. 2012 – 2017.