NICE published a clinical guideline on the treatment and management of depression in adults with chronic physical health problems in 2009.

This new evidence update refreshes that guidance by searching for new systematic reviews and randomised controlled trials on the subject and summarising them in a short (16 page) document.

The authors searched a range of databases from August 2010 onwards and found 6,400 references that they sifted through. In the end, they included just 13 references in their assessment, which was broadly in line with the existing guidance.

The key messages they produced are:

Care of all people with depression

• Evidence supports the positive impact of information provision, group physical activities and support programmes on depressive symptoms.

Stepped care

• Limited evidence in a single therapeutic area showed the benefit of collaborative care, possibly before earlier steps of intervention, but is unlikely to be sufficient to warrant a change in current recommendations.

Step 1: recognition, assessment and initial management in primary care and general hospital settings

• Some evidence in patients with a chronic physical health problem (cancer) supports the association between depression and mortality.

Step 2: recognised depression in primary care and general hospital settings – persistent subthreshold depressive symptoms or mild to moderate depression

• Evidence provides support for current guidance, including computerised cognitive behaviour therapy (CBT).

Step 3: recognised depression in primary care and general hospital settings – persistent subthreshold depressive symptoms or mild to moderate depression with inadequate response to initial intervention, and moderate and severe depression

• Although evidence supports the current recommendations for antidepressant pharmacotherapy or psychotherapeutic interventions (CBT or couples behaviour therapy), it does not indicate a preferred option.
• Evidence supports current guidance for antidepressant treatment in patients with depression and chronic physical health problems, although evidence is insufficient to guide the specific choice of medication.
• Current guidance that CBT is a preferred psychotherapeutic approach is supported by new evidence.
• Evidence supports the value of collaborative care, with a case manager and combined interventions.

The evidence update also highlighted one uncertainty around the use of SSRI antidepressants for patients with depression and coronary heart disease.

Links

Depression in adults with a chronic physical health problem: evidence update (PDF). NICE, March 2012.

Selective serotonin reuptake inhibitors (SSRIs) in patients with depression and coronary heart disease. UK Database of Uncertainties about the Effects of Treatments (DUETs), 12 Dec 2011.

Depression in adults with a chronic physical health problem. NICE, 2009.