NICE guidance on managing depression

The UK's National Institute for Health and Clinical Excellence (NICE) has published guidance on the treatment and management of depression in adults with chronic physical health problems such as cancer, heart disease and diabetes, which can have a serious impact on an individual's psychological wellbeing. Depression is approximately two to three times more common in patients with a chronic physical health problem than in those who have good physical health.

This guideline, produced for NICE by the National Collaborating Centre for Mental Health, makes recommendations on the identification, treatment and management of depression in adults aged 18 years and older that also have a chronic physical health problem.

Recommendations for those involved with the treatment and management of depression include:

· Case identification and recognition

· Low-intensity psychosocial interventions

· Offer of the following treatment choice for moderate depression: group-based Cognitive Behaviour Therapy (CBT), individual CBT or behavioural couples' therapy

· Antidepressant drugs should be considered for patients with: a past history of moderate or severe depression; mild depression that complicates the care of the physical health problem; initial presentation of sub-threshold depressive symptoms that have been present for a long period or sub-threshold depressive symptoms and mild depression that persist(s) after other treatments
 
· Collaborative care for patients whose depression has not responded to initial high-intensity psychological treatments, drug treatment or a combination of psychological and drug treatments.

Professor Steve Pilling, director of the National Collaborating Centre for Mental Health and director of the Centre for Outcomes Research and Effectiveness, University College London, said: "Depression is diagnosed in about 20 per cent of people with a chronic physical health problem and it can have a real impact on their quality of life - increasing the pain and distress and slowing down their recovery. Health practitioners need to be aware of the possibility of depression in their patients, especially if they suffer from a chronic physical health problem such as cancer, heart disease or diabetes. This is the first time that NICE has published guidance looking at depression in people with chronic physical health problems. It will help clinicians to provide the most effective treatments and bring real benefits for patients."