Common mental health problems: identification and pathways to care

Depression

If you have mild to moderate depression you should be offered a self-help programme, a treatment called 'computerised cognitive behavioural therapy', a physical activity (exercise) programme or, if you also have a long-term physical health problem, a peer support group. If you are pregnant or have recently given birth you should be offered counselling and support at home.

If self-help, computerised cognitive behavioural therapy, physical activity or peer support have not helped you, you should be offered either a psychological treatment, such as cognitive behavioural therapy (often called CBT) or treatments called 'interpersonal therapy', 'behavioural activation' or 'behavioural couples therapy', or an antidepressant.

You should not usually be offered drug treatment (antidepressants) for mild depression. However, if you have mild depression that has lasted a long time or has not improved after other treatments, if you have had moderate or severe depression in the past, or if your depression is affecting the treatment of a physical health problem, you may be offered an assessment for an antidepressant.

If you have moderate or severe depression you may be offered a psychological treatment (either CBT or interpersonal therapy) together with an antidepressant.

If you decide not to have an antidepressant or the psychological treatments mentioned above, you may be offered counselling or a type of treatment called 'short-term psychodynamic psychotherapy'. However, your healthcare professional should explain that it is uncertain whether counselling or short-term psychodynamic psychotherapy are helpful for people with depression.

If you have moderate or severe depression and a long-term physical health problem, and psychological treatments and antidepressants have not helped, you may be referred for long-term treatment and support from a dedicated team of professionals – this is called 'collaborative care'.

Psychological treatments can help you to understand how to stay well if there is a risk your depression may come back. CBT can help if you become unwell again or if your depression has improved but you still have some symptoms. 'Mindfulness-based cognitive therapy' can help if you are currently well but have had three or more episodes of depression in the past.

For further information on depression see www.nice.org.uk/guidance/CG90/PublicInfo

Generalised anxiety disorder

You should be offered self-help treatment or a group treatment with other people with generalised anxiety disorder (in which you will be offered advice and education about the disorder and coping with symptoms) as initial treatments for generalised anxiety disorder.

If your symptoms are seriously affecting you, or the initial treatments have not helped you, you should be offered a psychological treatment (CBT or a treatment called 'applied relaxation') or drug treatment.

For further information on generalised anxiety disorder see www.nice.org.uk/guidance/CG113/PublicInfo

Panic disorder

For mild to moderate panic disorder you should be offered self-help treatment. If you have moderate to severe panic disorder (with or without agoraphobia) you may be offered a referral for CBT or an antidepressant if you have had the disorder for a long time, psychological treatment has not helped you, or you decide not to have psychological treatment.

For further information on panic disorder see www.nice.org.uk/guidance/CG113/PublicInfo

Obsessive-compulsive disorder

If you have mild to moderate OCD you should be offered CBT that is adapted for people with OCD and includes a technique called 'exposure and response prevention' (called ERP for short); you may be able to do this treatment on your own with a self-help book, by telephone or in a group with other people with OCD.

If you have moderate OCD you should be offered CBT (including ERP) or an antidepressant; if you have severe OCD you should be offered CBT (including ERP) together with an antidepressant. You should be offered treatment at home if you are not able to attend a clinic or have problems related to your OCD that make this necessary.

If you have symptoms that have lasted a long time or are severely affecting your life, you may be offered an appointment with a specialist mental health service.

For further information on OCD see www.nice.org.uk/guidance/CG31/PublicInfo

Post-traumatic stress disorder

If you have PTSD you should be offered psychological treatment (called 'trauma-focused CBT' or 'eye movement desensitisation and reprocessing' or EMDR for short).

You may be offered drug treatment if you prefer it or decide not to have psychological treatment.

For further information on PTSD see www.nice.org.uk/guidance/CG26/PublicInfo

Social anxiety disorder

Advice about social anxiety disorder is being developed by NICE (due to be published in 2013).

Common mental health disorders during and following pregnancy

If you are pregnant or have recently given birth and are offered psychological treatment, you should receive it within 3 months (ideally within 1 month). It is important to treat mental health problems during pregnancy and after giving birth as quickly as possible because of the possible effect of the mental health problem on you and your baby. If you have had depression or anxiety before, you should be offered psychological treatments (CBT or interpersonal therapy).

For further information on common mental health problems during or after pregnancy see www.nice.org.uk/guidance/CG45/PublicInfo

If you have more than one mental health problem

If you have both depression and anxiety, the condition that causes you the most problems may be treated first. Because treatments for anxiety and depression are similar, treatment for one condition can often help the other.

If you have a common mental health problem and are dependent on alcohol, you should be offered treatment for alcohol dependence first as this may lead to improvements in symptoms of depression and anxiety.

For further information on alcohol dependence see www.nice.org.uk/guidance/CG115/PublicInfo