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Depression in Adults with a Chronic Physical Health Problem: Treatment and Management

Depression in Adults with a Chronic Physical Health Problem: Treatment and Management

NICE Clinical Guidelines - National Collaborating Centre for Mental Health (UK)

Version: 2010

PHARMACOLOGICAL INTERVENTIONS IN THE TREATMENT AND MANAGEMENT OF DEPRESSION IN ADULTS WITH A CHRONIC PHYSICAL HEALTH PROBLEM

Since the introduction of monoamine oxidase inhibitors (MAOIs) and the first TCA, imipramine, in the late 1950s, many new antidepressants have been introduced and approximately 35 different antidepressants in a number of classes are currently available worldwide. There has been intensive research on the effects of drug therapy on depression and how drugs might alter the natural history of the disorder. A large number of reviews and meta-analyses have been conducted that sought to synthesise this vast literature, which includes those conducted for the first NICE depression guideline (NCCMH, 2004a) and the update (NCCMH, 2010).

SUMMARY OF RECOMMENDATIONS

Inform patients with depression and a chronic physical health problem about self-help groups, support groups and other local and national resources for people with depression.

SERVICE-LEVEL INTERVENTIONS FOR PEOPLE WITH DEPRESSION AND A CHRONIC PHYSICAL HEALTH PROBLEM

There have been a number of responses over the past 20 years or so to address the problem of suboptimal treatment of depression, including depression in people with a chronic physical health problem. These responses have included developments in the treatment of depression in primary and secondary care; advances in the organisational and professional structures of primary and secondary care mental health services; and the development and adaptation of models for the management of chronic physical health problems, for example diabetes (von Korff & Goldberg, 2001; von Korff et al., 1997). Since the publication of the first NICE guideline on depression in 2004, these developments have included the introduction of graduate mental health workers in the UK (Department of Health, 2003), which has contributed to increased access to low-intensity psychosocial interventions including computerised cognitive behavioural therapy (CCBT) (NICE, 2002; NICE, 2005). The concept of ‘stepped care’ advocated in the first depression guideline has been embraced by many commissioners and providers in the NHS and is now being taken forward by the Improving Access to Psychological Therapies (IAPT) programme (Department of Health, 2007). It is this later development, with £340 million of funding over 6 years along with 3,400 new psychological therapists, which will bring the single biggest change to the provision of effective treatments for depression in primary and secondary care.

PSYCHOLOGICAL AND PSYCHOSOCIAL INTERVENTIONS FOR PEOPLE WITH DEPRESSION AND A CHRONIC PHYSICAL HEALTH PROBLEM

Depression is one of several problems faced by people with a chronic physical health problem. The other problems include the symptoms of the physical illness itself (for example, pain and weakness), the consequent impairment of social and occupational functioning (for example, restricted mobility and prevention of valued activities), the changes in lifestyle necessitated by the illness or its treatment (for example, dietary restrictions and renal dialysis) and the side effects of medication. Depression in this context is significant because it can exacerbate the symptoms and disabling effects of the physical illness, but it is also potentially treatable. Successful treatment of depression may offer one of the few ways in which the health-related quality of life of people with a chronic physical health problem can be improved.

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