This site is intended for healthcare professionals

Go to /sign-in page

You can view 5 more pages before signing in

Step 1 - NICE guidance - recognition of depression in primary care and general hospital settings

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

Authoring team

Step 1: recognition, assessment and initial management

  • identifying people with depression
    • health professionals should be alert to possible depression (particularly in people with a past history of depression or a chronic physical health problem with associated functional impairment) and consider asking:
      • during the last month, have you often been bothered by:
        • feeling down, depressed or hopeless?
        • having little interest or pleasure in doing things?

    • if the person answers 'yes' to either question
      • a practitioner who is competent in mental health assessment should:
        • review the person's mental state and associated functional, interpersonal and social difficulties
        • consider using a validated measure for symptoms, functions and/or disability
        • for people with language or communication difficulties, consider using the Distress Thermometer and/or asking a family member or carer about symptoms; if significant distress is identified
      • a practitioner who is not competent in mental health assessment should:
        • refer the person to an appropriate professional - if this is not the person's GP, inform the GP

    • if the person also has a chronic physical health problem:
      • ask three further questions to improve the accuracy of the assessment:
        • during the last month, have you often been bothered by:
          • feelings of worthlessness?
          • poor concentration?
          • thoughts of death?
      • consider the role of the physical health problem and any prescribed medication in the depression
      • check that the optimal treatment for the physical health problem is being provided and adhered to; seek specialist advice if necessary

  • assessment and initial management
    • for a person who may have depression, conduct a comprehensive assessment that does not rely simply on a symptom count. Take into account:
      • the degree of associated functional impairment and/or disability
      • the duration of the episode
    • health professionals should explore how the following may have affected the development, course and severity of the depression:
      • history of depression and comorbid mental health or physical disorders
      • any past history of mood elevation
      • response to previous treatments
      • the quality of interpersonal relationships
      • living conditions and social isolation
    • if the person has a learning disability or acquired cognitive impairment:
      • consider consulting a relevant specialist when developing treatment plans
      • where possible, provide the same interventions as for other people with depression; adjust the method of delivery or duration if necessary
    • always ask a person with depression directly about suicidal ideation and intent. If there is a risk of self-harm or suicide:
      • assess whether they have adequate social support and are aware of sources of help
      • arrange help appropriate to the level of risk
      • advise them to seek help if the situation deteriorates

Risk assessment and monitoring

  • if the person presents considerable immediate risk to themselves or others, refer them urgently to specialist mental health services
  • advise the person and their family or carer of the following, and ensure they know how to seek help promptly if required:
    • the potential for increased agitation, anxiety and suicidal ideation early in treatment; actively seek out these symptoms and review treatment if they develop marked and/or prolonged agitation
    • the need to be vigilant for mood changes, negativity, hopelessness and suicidal ideation, particularly when starting or changing treatment and at times of increased stress
  • If the person is assessed to be at risk of suicide, consider:
    • take into account toxicity in overdose if an antidepressant is prescribed or the person is taking other medication; if necessary, limit the amount of drug(s) available
    • consider increasing the level of support, such as more frequent direct or telephone contacts
    • consider referral to specialist mental health services

For more detailed information then consult full guideline (1).

Reference:

  1. NICE (April 2018). Depression.

Create an account to add page annotations

Add information to this page that would be handy to have on hand during a consultation, such as a web address or phone number. This information will always be displayed when you visit this page

The content herein is provided for informational purposes and does not replace the need to apply professional clinical judgement when diagnosing or treating any medical condition. A licensed medical practitioner should be consulted for diagnosis and treatment of any and all medical conditions.

Connect

Copyright 2024 Oxbridge Solutions Limited, a subsidiary of OmniaMed Communications Limited. All rights reserved. Any distribution or duplication of the information contained herein is strictly prohibited. Oxbridge Solutions receives funding from advertising but maintains editorial independence.