NICE Issues Guidance For Adults With Depression And Chronic Physical Health Problems

Main Category: Depression
Also Included In: Mental Health;  Psychology / Psychiatry;  Public Health
Article Date: 29 Oct 2009 - 6:00 PDT

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The 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.

Chronic physical health problems such as cancer, heart disease or diabetes 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 people 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, such as cancer, heart disease, diabetes, or a musculoskeletal, respiratory or neurological disorder.v
Recommendations for those involved with the treatment and management of depression include:

-- Case identification and recognition - Be alert to possible depression, particularly in patients with a past history of depression or a chronic physical health problem with associated functional impairment.

-- Low-intensity psychosocial interventions - For patients with persistent sub threshold depressive symptoms or mild to moderate depression and a chronic physical health problem, and for patients with sub threshold depressive symptoms that complicate the care of the chronic physical health problem, guided by the patient's preference consider offering: a structured group physical activity programme, a group-based peer support (self-help) programme, individual guided self-help based on the principles of cognitive behavioural therapy (CBT)1, or computerised cognitive behavioural therapy (CCBT) 2.

-- Treatment for moderate depression - For patients with initial presentation of moderate depression and a chronic physical health problem, offer the following choice of high-intensity psychological interventions:

- group-based CBT or
- individual CBT for patients who decline group-based CBT or
- for whom it is not appropriate, or where a group is not available or
- behavioural couples therapy for people who have a regular partner and where the relationship may contribute to the development or maintenance of depression, or where involving the partner is considered to be of potential therapeutic benefit.

-- Antidepressant drugs - Do not use antidepressants routinely to treat sub threshold 3 depressive symptoms or mild depression in patients with a chronic physical health problem, but consider them for patients with:

- a past history of moderate or severe depression or
- mild depression that complicates the care of the physical health problem or
- initial presentation of sub threshold depressive symptoms that have been present for a long period (typically at least 2 years) or
- sub threshold depressive symptoms or mild depression that persist(s) after other treatments.

When an antidepressant is to be prescribed for a patient with depression and a chronic physical health problem, take into account the presence of additional physical health disorders, the side effects of antidepressants, which may impact on the underlying physical disease.

-- Collaborative care - Consider collaborative care 4 for patients with moderate to severe depression and a chronic physical health problem 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, National Collaborating Centre for Mental Health; Director, Centre for Outcomes Research and Effectiveness, University College London said "Depression is diagnosed in about 20% 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."

Dr John Hindle, Consultant Physician Care of the Elderly, Betsi Cadwaladr University Local Health Board and member of the Guideline Development Group said: "Effectively treating depression in people with a chronic physical health problem can make a real difference to their quality of life. The new guideline gives clear information about any drug interactions to inform decisions made with individual patients and ensure the right medication is prescribed."

Dr David Kessler, GP, Walport Clinical Lecturer in Primary Care, Bristol University and member of the Guideline Development Group said: "Living with a chronic health problem can and often does affect mental wellbeing; it can cause or intensify depression. We need to ask people with chronic health problems if they are suffering from depression. This new guideline is important in raising awareness among patients and doctors of the combination of the two conditions and helping them identify symptoms early and more effectively."

Ms Margaret Ogden, service user and carer representative on the Guideline Development Group said: "The guideline is so important to patients as it provides a diverse choice of treatments, enabling them to confront their depression head on. Offering collaborative care has great benefits, in that a patient's care is managed by one person ensuring the channels of communication between healthcare professionals remain open, allowing patients to be more confident and better informed about their treatment."

Source
NICE