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Quick reference guide for healthcare professionals
in general hospital settings

Issue date: October 2009

Depression in adults with a chronic
physical health problem
Treatment and management




NICE clinical guideline 91
Developed by the National Collaborating Centre for Mental Health

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Depression and chronic physical health problems




About this booklet
This quick reference guide summarises the recommendations NICE has made to the NHS in
`Depression in adults with a chronic physical health problem: treatment and management' (NICE
clinical guideline 91) that are relevant to healthcare professionals in general hospital settings. Note…

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Depression and chronic physical health problems Introduction




Introduction
Depression is approximately two to three times more common in patients with a chronic physical
health problem (such as cancer, heart disease or diabetes) than in people who have good physical
health. A chronic physical health problem can both cause and exacerbate…

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Depression and chronic physical health problems Step 1




Step 1
Identifying depression
Ask a patient who may have depression:
During the last month, have you often been bothered by:
­ feeling down, depressed or hopeless?
­ having little interest or pleasure in doing things? KPI



If the patient answers `yes'…

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Depression and chronic physical health problems Step 2




Step 2
Sleep hygiene
Offer advice on sleep hygiene, including:
­ establishing regular sleep and wake times
­ avoiding excess eating, smoking or drinking alcohol before sleep
­ creating a proper environment for sleep
­ taking regular physical exercise if possible.

Active…

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Depression and chronic physical health problems Steps 3 and 4




Step 3
Treatment options
Target population Treatment options
Patients with persistent subthreshold An antidepressant (see pages 8­9) or
depressive symptoms or mild to A high-intensity psychological intervention (group CBT,
moderate depression who have not individual CBT or behavioural couples therapy)…

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Depression and chronic physical health problems Care of people with depression




Care of people with depression
Principles of care
Be aware that stigma and discrimination can be associated with a diagnosis of depression, and
ensure that the patient's confidentiality, privacy and dignity are respected.
Be sensitive to diverse cultural, ethnic…

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Depression and chronic physical health problems Antidepressants




Antidepressants
Choice of antidepressants4
When prescribing an antidepressant, take into account:
­ the presence of other physical health problems
­ side effects (which may impact on the underlying physical disease)
­ that there is currently no evidence supporting using specific antidepressants for patients…

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Depression and chronic physical health problems Antidepressants




If the patient develops side effects early on, provide information and consider:
­ monitoring symptoms closely if side effects are mild and acceptable to the patient or
­ stopping or changing to a different antidepressant if the patient prefers or
­ short-term concomitant…

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Depression and chronic physical health problems Further information




Further information
Ordering information For printed copies of the quick reference guides
You can download the following documents from or `Understanding NICE guidance', phone
www.nice.org.uk/CG91 NICE publications on 0845 003 7783 or email
[email protected] and quote:
The NICE guideline ­ all the…

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