Page last updated at 00:03 GMT, Wednesday, 28 October 2009

'Talk therapy' for the depressed

Woman with head in hands
Depression is more common in people with chronic physical problems

Antidepressants should not be used routinely to treat depression in adults with chronic health problems, according to the treatment regulator, NICE.

Depression is two to three times more common in patients with problems such as cancer, heart disease and diabetes.

NICE recommends structural physical activities and talking therapies for mild to moderate problems.

But charities said the guidance could be interpreted as an excuse to cut face-to-face counselling services.

'Serious impact'

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.

Depression can be a complex issue and while CBT can bring huge benefits to many people, for others it isn't always the right approach
Paul Farmer, Mind

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.

The doctor should also consider if the patient is receiving the best kind of treatment for their physical health problem, ask about history of depression and whether relationships or living conditions are having an impact.

Treatment choices

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.

It also recommends couples therapy for people who have a regular partner and where the relationship may contribute to the depression, or where involving the partner can be a therapeutic benefit.

Nice says antidepressants should only be considered for patients with a past history of moderate or severe depression, those who have mild depression that complicates the care of the physical health problem, or those whose depression has lasted for at least two years or persists after other treatments.

Professor Steve Pilling, director of the National Collaborating Centre for Mental Health, said: "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."

But Paul Farmer, of the mental health charity Mind, said: "We are concerned that the stronger focus on CBT over counselling will be interpreted by health services as an excuse to cut counselling services.

"Depression can be a complex issue and while CBT can bring huge benefits to many people, for others it isn't always the right approach and there is no substitute for talking through long-term issues with a counsellor."

"The supply of talking therapies is still below the demand and providers need to increase the availability of all talking treatments across the board."



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SEE ALSO
Depression 'cuts cancer survival'
14 Sep 09 |  Health
GPs 'poor at spotting depression'
27 Jul 09 |  Health
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