Depression is a common mental disorder that typically presents with a range of symptoms and varying levels of impairment in social and occupational functioning.<\/p>\n\n\n\n
ICD 10 Diagnostic Criteria<\/span>:<\/strong><\/p>\n\n\n\n Depression is defined as the presence of pervasive low mood and a loss of interest and enjoyment in activities, occurring most of the day, nearly every day, for at least 2 weeks, as well as other symptoms such as:<\/p>\n\n\n\n Assessment also includes consideration of onset, duration, pattern and severity of symptoms, as well as impact on functioning, risk of self-harm and suicide.<\/p>\n\n\n\n Depressive episodes are subdivided into less severe (encompassing subthreshold and mild depression) and more severe (encompassing moderate and severe depression).<\/p>\n\n\n\n Initial support should include psychoeducation<\/a> (this link can be shared with patients<\/em>) and activities that could improve the person\u2019s sense of wellbeing. Treatment should take a shared decision-making approach and follows a matched care model<\/a>.<\/p>\n\n\n\n Consideration should be given to situational factors such as housing, financial, occupational, social or relationship instability or difficulties that might benefit from an alternative approach through third sector organisations (e.g. Citizen\u2019s Advice Bureau, relationship counselling, Women\u2019s Aid).<\/p>\n\n\n\n For less severe depressive episodes<\/span>, which can be driven by situational stress, lower intensity options include:<\/p>\n\n\n\n There is more detail on the mental health locality page<\/a>.<\/p>\n\n\n\n For more severe or chronic depression, or less severe depression that has not responded to lower intensity interventions above<\/span>, treatment options are ideally both:<\/p>\n\n\n\n Patients in crisis, or at high risk of suicide, should be risk assessed and considered for emergency mental health services<\/a>.<\/p>\n\n\n\n Antidepressant treatment<\/span><\/p>\n\n\n\n It is generally expected that the GP will have tried two antidepressants and considered psychological approaches, including CBT, before seeking further advice. The Formulary recommendation is to try two different SSRIs initially. Lithium for treatment and prophylaxis of recurrent major depressive disorder [unipolar depression] should only be initiated by a specialist (BNF advice)<\/span><\/p>\n\n\n\n Psychological treatment<\/span><\/p>\n\n\n\n Information about different psychological therapies and interventions can be found on the Matrix Guide to Delivering Evidence Based Psychological Therapies and Interventions in Scotland.<\/a> The search facility<\/a> for a particular condition or type of patient is helpful.<\/p>\n\n\n\n Information on referral criteria for psychological therapy can be found here<\/a>. Accepted referrals for psychological treatment will usually involve an initial suitability assessment appointment before being added to a treatment waiting list. Some interventions are delivered in group format, but referral for this follows the same pathway and suitability assessment.<\/p>\n\n\n\n Psychology and locality mental health services are for adults aged 18-64: please refer to CAMHS or Older People\u2019s Mental Health services for those outwith that age range. The exception is online and specific psychoeducational programmes such as Guided Self Help or cCBT.<\/p>\n\n\n\n LB & CM 26\/6\/26<\/strong><\/p>\n\n\n\n Locality Mental Health Services<\/span><\/p>\n\n\n\n If a person\u2019s symptoms of depression have not responded to medication or psychological therapy, consider re-visiting other factors (e.g. personal, social or environmental) or adherence to treatment, and discuss options for alternative medication or psychological treatment. This is also an indication for referral. Nice guidelines have a helpful infographic<\/a> to aid this.<\/p>\n\n\n\n NICE CKS summaries are very useful:<\/p>\n\n\n\n <\/p>\n\n\n\n Initial primary care management<\/a> with a range of patient information sources too<\/p>\n\n\n\n Ongoing management<\/a> including 2nd<\/sup> line therapies and reducing relapse<\/p>\n\n\n\n Antidepressant prescribing<\/a><\/p>\n\n\n\n An overview of antidepressant drug classes<\/a> and their complications.<\/p>\n\n\n\n Please refer via SCI Gateway to your locality mental health team<\/a>. Please include an outline of patient\u2019s current presentation and a brief summary of known past treatments is helpful.<\/p>\n\n\n\n <\/p>\n<\/div><\/div>\n\n\n\n Depression PHQ9 questionnaire<\/a><\/p>\n\n\n\n NICE<\/a> defines less severe and more severe depression:<\/p>\n\n\n\n GAD-7 questionnaire<\/a><\/p>\n\n\n\n NICE<\/a> outlines that scores of 5, 10, and 15 are taken as cut-off points for mild, moderate, and severe anxiety respectively. <\/p>\n\n\n\n Major Depression MDI Questionnaire<\/a>:<\/p>\n\n\n\n Please see scoring detail in Mental Health – Scoring of MDI Major Depression_Inventory.pdf<\/a><\/p>\n\n\n\n East Region Formulary<\/a><\/p>\n\n\n\n Management and monitoring of patients using Lithium:<\/span><\/p>\n\n\n\n NHS Scotland \/ CMO Lithium guideline – https:\/\/www.sehd.scot.nhs.uk\/cmo\/CMO(2019)04.pdf<\/a><\/p>\n\n\n\n [Psychiatrists asking GPs to start people on Lithium should send clear instructions; and have fully counselled patients and undertaken any baseline investigations required]<\/p>\n\n\n\n Patients with renal impairment secondary to Lithium \u2013 Review Article<\/p>\n\n\n\n Lithium and chronic kidney disease; Mukesh Kripalani et al; BMJ 2009;339:b2452 (https:\/\/www.bmj.com\/content\/339\/bmj.b2452<\/a>)<\/p>\n<\/div><\/div>\n<\/div>\n","protected":false},"excerpt":{"rendered":" Description Depression is a common mental disorder that typically presents with a range of symptoms and varying levels of impairment in social and occupational functioning. ICD 10 Diagnostic Criteria: Depression is defined as the presence of pervasive low mood and a loss of interest and enjoyment in activities, occurring most of the day, nearly every<\/p>\n","protected":false},"author":2,"featured_media":0,"parent":4125,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_searchwp_excluded":"","footnotes":""},"categories":[323],"class_list":["post-3841","page","type-page","status-publish","hentry","category-depressionadult"],"publishpress_future_workflow_manual_trigger":{"enabledWorkflows":[]},"rttpg_featured_image_url":null,"rttpg_author":{"display_name":"NHS Lothian","author_link":"https:\/\/apps.nhslothian.scot\/refhelp\/author\/nhs-lothian\/"},"rttpg_comment":0,"rttpg_category":" Depression (Adult)<\/a>","rttpg_excerpt":"Description Depression is a common mental disorder that typically presents with a range of symptoms and varying levels of impairment in social and occupational functioning. ICD 10 Diagnostic Criteria: Depression is defined as the presence of pervasive low mood and a loss of interest and enjoyment in activities, occurring most of the day, nearly every","_links":{"self":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/3841","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/comments?post=3841"}],"version-history":[{"count":18,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/3841\/revisions"}],"predecessor-version":[{"id":28626,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/3841\/revisions\/28626"}],"up":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/4125"}],"wp:attachment":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/media?parent=3841"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/categories?post=3841"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}\n
Treatment<\/span><\/h4>\n\n\n\n
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Who to refer:<\/h4>\n\n\n\n
Who not to refer:<\/h4>\n\n\n\n
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How to refer:<\/h4>\n\n\n\n
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Scoring Tools<\/span><\/h4>\n\n\n\n
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Self Help, Lifestyle and Community Engagement:<\/span><\/h4>\n\n\n\n
Online self-help resources:<\/span><\/h5>\n\n\n\n
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Local online mental health information:<\/span><\/h5>\n\n\n\n
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Prescribing:<\/strong><\/span><\/h4>\n\n\n\n