Depression is two to three times more common in patients with problems such as cancer, heart disease and diabetes. Antidepressants should not be used routinely to treat depression in adults with chronic health problems, according to the treatment regulator, NICE. NICE recommends structural physical activities and talking therapies, known as CBT, for mild to moderate problems.
The National Institute for Health and Clinical Excellence says chronic physical health problems can have a serious impact on an individual’s psychological wellbeing. It says doctors should be alert to possible depression, particularly in patients with a past history of depression or where the health problem causes serious functional impairment. The new guidance sets out two key questions patients should be asked if a doctor suspects they may be at risk of depression. They are: “During the last month, have you often been bothered by feeling down depressed or hopeless? “Or have you had little interest or pleasure in doing things?”If the patient says yes, the doctor should refer a patient on to a specialist or, if they are trained in mental health assessment, ask a further three questions. These will check if the patient has, in the last month, been bothered by feelings of worthlessness, poor concentration or thoughts of death.
NICE says structured group physical activities, peer support or self-help based on the principles of cognitive behaviour therapy (CBT) and computerised CBT should be used for mild to moderate depression.