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'Referral advice' recommendation details

Depression in adults (update)

Guidance ID NICE 'referral advice' recommendation 'Referral advice' category
CG90 If a person answers 'yes' to either of the depression identification questions: During the last month, have you often been bothered by: - feeling down, depressed or hopeless? - having little interest or pleasure in doing things? but the practitioner is not competent to perform a mental health assessment, they should refer the person to an appropriate professional. If this professional is not the person's general practitioner (GP), inform the general practitioner (GP) of the referral. Time frame not specified
CG90 If a person with depression presents considerable immediate risk to themselves or others, refer them urgently to specialist mental health services. If a person with depression is assessed to be at risk of suicide: 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 and consider increasing the level of support, such as more frequent direct or telephone contacts or consider referral to specialist mental health services. Urgent
CG90 For people with severe depression and those with moderate depression and complex problems, consider referring to specialist mental health services for a programme of coordinated multiprofessional care. Time frame not specified
CG90 For a person whose depression has failed to respond to various strategies for augmentation and combination treatments, consider referral to a practitioner with a specialist interest in treating depression, or to a specialist service. Time frame not specified
CG90 Referral to specialist mental health services should normally be for people with depression who are at significant risk of self-harm, have psychotic symptoms, require complex multiprofessional care, or where an expert opinion on treatment and management is needed. The assessment of a person with depression referred to specialist mental health services should include: - their symptom profile, suicide risk and previous treatment history - associated psychosocial stressors - personality factors and significant relationship difficulties - any history of chronic or recurrent depression or associated comorbidities including alcohol and substance misuse, and personality disorders Time frame not specified
CG90 When assessing a person with suspected depression, be aware of any learning disabilities or acquired cognitive impairments, and if necessary consider consulting with a relevant specialist when developing treatment plans and strategies. Time frame not specified
CG90 People with depression who are considered to be at significant risk of relapse (including those who have relapsed despite antidepressant treatment or who are unable or choose not to continue antidepressant treatment) or who have residual symptoms, should be offered one of the following psychological interventions: - individual cognitive behavioural therapy (CBT) for people who have relapsed despite antidepressant medication and those with a significant history of depression and residual symptoms despite treatment - mindfulness-based cognitive therapy for people who are currently well but have experienced three or more previous episodes of depression. Time frame not specified
CG90 For people with persistent subthreshold depressive symptoms or mild to moderate depression, consider offering one or more of the following interventions, guided by the person's preference: - individual guided self-help based on the principles of cognitive behavioural therapy (CBT) - computerised cognitive behavioural therapy (CCBT) - a structured group physical activity programme. Time frame not specified
CG90 Consider inpatient treatment for people with depression who are at significant risk of suicide, self-harm or self-neglect discharge

This page was last updated: 22 August 2012

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Copyright 2014 National Institute for Health and Care Excellence. All rights reserved.

Accessibility | Cymraeg | Freedom of information | Vision Impaired | Contact Us | Glossary | Data protection | Copyright | Disclaimer | Terms and conditions

Copyright 2014 National Institute for Health and Care Excellence. All rights reserved.