depression with physical health quick

depression with physical health quick

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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
that not all recommendations from the guideline are included, so please refer to the guideline
if further details are needed (see www.nice.org.uk/CG91niceguideline).…read more

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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 depression, and treating
depression in these patients has the potential to increase their quality of life and life expectancy.…read more

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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' to either question
A practitioner who is not competent
in mental health assessment should:
refer the patient to an appropriate
professional ­ if this is not the
patient's GP, inform the GP.…read more

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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.…read more

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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) 3.
benefited from a low-intensity
psychosocial intervention
Patients who present initially with A high-intensity psychological intervention (group CBT,
moderate depression individual CBT or behavioural couples therapy) 3.…read more

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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 and religious backgrounds, and aware of possible variations
in presentation.
Be aware of any learning disabilities or acquired cognitive impairments ­ if necessary consider
consulting with a relevant specialist.…read more

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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 with
particular physical health problems.…read more

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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 treatment (no longer than 2 weeks) with a benzodiazepine if anxiety,
agitation and/or insomnia are problematic, except in patients with chronic symptoms of anxiety;
use with caution in patients at risk of falls.…read more

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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 recommendations.
N2018 (this quick reference guide)
A quick reference guide summarising relevant
recommendations for healthcare professionals N2016 (`combined' quick reference guide)
in general hospital settings (this document). N2019 (`Understanding NICE guidance').…read more

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