Table 1.
Diagnosis and treatment of clinical depression in people with chronic diseases
| Diagnosis according to the International Classification of Diseases 10th edition (ICD‐10) | Stepped care treatment model according to NICE guidelines 5 |
|---|---|
| Criteria | Mild or subthreshold depression |
| For at least 2 weeks (or less if symptoms are severe and of rapid onset), the following 2 core symptoms present | Group physical activity programme, group‐based peer support or to low‐intensity psychological interventions (e.g. group CBT or computerized CBT) |
| Low mood | Antidepressants if symptoms are persistent or unresponsive to above |
| Anhedonia (loss of interest and enjoyment) | |
| Low energy | |
| Plus at least 2 associated symptoms | Moderate depression |
| Reduced concentration and attention | Antidepressant medication (SSRI usual first‐line) for minimum of 6 months; alternatives include mirtazapine, SNRI, tricyclics (caution because of toxicity in overdose) |
| Reduced self‐esteem and self‐confidence | High‐intensity psychological therapy (e.g. individual CBT) |
| Ideas of guilt and unworthiness (even in a mild type of episode) | Combination of antidepressants and psychological therapy (most evidence‐based) |
| Bleak and pessimistic views of the future | |
| Ideas or acts of self‐harm or suicide | |
| Disturbed sleep | |
| Diminished appetite | |
| Severity | Severe depression |
| Mild depression defined with minimum 2 core symptoms and total of 4 symptoms (core or other) | As per moderate depression, but referral to specialist mental services recommended if risk of self‐harm, suicide or severe self‐neglect |
| Moderate depression defined with minimum 2 core symptoms and total of 6 symptoms | Specialist treatments may include augmentation with lithium, anti‐psychotic medication or ECT |
| Severe depression defined with all 3 core symptoms and total of 8 symptoms. Psychotic symptoms (e.g. delusions, hallucinations) may or may not be present |
CBT = cognitive behavioural therapy; ECT = electroconvulsive therapy; ICD = International Classification of Diseases; NICE = National Institute for Health and Care Excellence; SNRI = serotonin and noradrenaline reuptake inhibitor; SSRI = selective serotonin reuptake inhibitor.