depression with physical health

depression with physical health

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Understanding NICE guidance
Information for people who use NHS services
Treating depression in adults
with a long-term physical
health problem
NICE `clinical This booklet is about the care and treatment of depression in people with
guidelines' advise a long-term physical health problem (such as cancer, a heart condition
or diabetes) in the NHS in England and Wales. It explains guidance (advice)
the NHS on caring
from NICE (the National Institute for Health and Clinical Excellence).
for people with It is written for people with depression and a long-term physical health
specific conditions problem but it may also be useful for their families or carers or for
or diseases and the anyone with an interest in this subject.
treatments they The booklet is to help you understand the care and treatment options
should receive. that should be available in the NHS. It does not describe depression
or the treatments for it in detail. A member of your healthcare team
should discuss these with you. There are examples of questions you
could ask throughout this booklet to help you with this. You can get
more information from the organisations listed on page 19. Technical
words and terms printed in bold type are explained on page 18.
NICE has also produced a booklet called `Treating depression in adults'
(see that gives information about
treatments for depression in people who do not have a long-term
physical health problem.
Information about NICE clinical guideline 91
Issue date: October 2009

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Page 2

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Your care 3
Depression and long-term physical health problems 4
What should happen when I first talk to a healthcare 5
professional about depression?
Who will provide my treatment for depression? 7
What treatments should I be offered for depression? 7
Treatments for mild to moderate depression 9
Treatments for moderate or severe depression 12
Treatment and care for people who are referred to a 16
specialist mental health service
Information for families and carers 17
Explanation of technical words and terms 18
More…read more

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Your care
In the NHS, patients and healthcare professionals have rights
and responsibilities as set out in the NHS Constitution
( All NICE
guidance is written to reflect these. You have the right to be involved in
discussions and make informed decisions about your treatment and care
with your healthcare team. Your choices are important and healthcare
professionals should support these wherever possible. You should be
treated with dignity and respect.…read more

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Depression and long-term physical health problems
Having a long-term physical health problem (such as cancer, a heart
condition, diabetes, disabilities caused by a stroke, respiratory disease,
kidney disease, arthritis or multiple sclerosis) can be distressing and difficult
to cope with. In some people this can lead to depression, although they
may not be aware that they are depressed.
Depression is a common mental health problem ­ it affects nearly 1 in
6 people in the UK (whether or not they have a physical health problem).…read more

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Healthcare professionals may use different terms for depression, such as
`major depressive disorder' or `clinical depression'.
Sometimes a person has very few symptoms of depression that don't
affect their life too much in the short term but can do if they continue for
a long time ­ `dysthymia' is a term that is sometimes used when a person
has very few symptoms lasting for 2 years or more.…read more

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Some people find it difficult to discuss their depression, so your
confidentiality, privacy and dignity should be respected at all times.
Healthcare professionals should be aware of any sensitive issues relating
to being diagnosed with depression, and should build a relationship with
you based on openness, trust, hope and optimism. They should explain
the different ways in which depression develops. They should also
discuss the treatments described in this booklet with you and explain that
these can help people to recover from depression.…read more

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Who will provide my treatment for depression?
Most people with depression are cared for by their GP, as are most people
with a long-term physical health problem. Your GP might involve other
healthcare professionals, such as a nurse or a mental health worker, in
your care. If a hospital doctor is providing care for your physical health
problem, they may also be involved in some aspects of your care for
depression if they are experienced in treating mental health problems.…read more

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If you have both depression and anxiety, you will be treated first for the
one that causes you the most problems. Because treatments for anxiety
and depression are similar, treatment for one condition can often help
the other.
Once you have started treatment, your healthcare professional should
check whether you are feeling anxious or agitated or having thoughts
about suicide. They should make sure you know who to contact for help
if you find these thoughts and feelings distressing.…read more

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Treatments for mild to moderate depression
Mild depression can sometimes get better by itself without treatment or by
following advice from your GP (or other healthcare professional) on coping
with problems and improving sleep. They should offer you advice on going
to bed and getting up at regular times, not eating large meals or smoking
or drinking alcohol just before going to bed, and taking regular exercise (if
this is possible) as this can also improve sleep.…read more

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Initial treatments for mild to moderate depression in people with a long-term physical health problem1
What treatment What does it involve? How long does it
have I been offered? usually last?
Physical activity A group exercise class. The instructor will take into account G Usually 2 or 3 sessions
programme how each person's physical ability might be affected by a week (lasting
their particular health problem.…read more


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