- Incidence: 1000.00 cases per 100,000 person-years
- Peak incidence: 40-50 years
- Sex ratio: more common in females 2:1
The following two questions can be used to screen for depression
- 'During the last month, have you often been bothered by feeling down, depressed or hopeless?'
- 'During the last month, have you often been bothered by having little interest or pleasure in doing things?'
A 'yes' answer to either of the above should prompt a more in depth assessment.
There are many tools to assess the degree of depression including the Hospital Anxiety and Depression (HAD) scale and the Patient Health Questionnaire (PHQ-9).
Hospital Anxiety and Depression (HAD) scale
- consists of 14 questions, 7 for anxiety and 7 for depression
- each item is scored from 0-3
- produces a score out of 21 for both anxiety and depression
- severity: 0-7 normal, 8-10 borderline, 11+ case
- patients should be encouraged to answer the questions quickly
Patient Health Questionnaire (PHQ-9)
- asks patients 'over the last 2 weeks, how often have you been bothered by any of the following problems?'
- 9 items which can then be scored 0-3
- includes items asking about thoughts of self-harm
- depression severity: 0-4 none, 5-9 mild, 10-14 moderate, 15-19 moderately severe, 20-27 severe
NICE use the DSM-IV criteria to grade depression:
- 1. Depressed mood most of the day, nearly every day
- 2. Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day
- 3. Significant weight loss or weight gain when not dieting or decrease or increase in appetite nearly every day
- 4. Insomnia or hypersomnia nearly every day
- 5. Psychomotor agitation or retardation nearly every day
- 6. Fatigue or loss of energy nearly every day
- 7. Feelings of worthlessness or excessive or inappropriate guilt nearly every day
- 8. Diminished ability to think or concentrate, or indecisiveness nearly every day
- 9. Recurrent thoughts of death, recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide
|Subthreshold depressive symptoms||Fewer than 5 symptoms|
|Mild depression||Few, if any, symptoms in excess of the 5 required to make the diagnosis, and symptoms result in only minor functional impairment|
|Moderate depression||Symptoms or functional impairment are between 'mild' and 'severe'|
|Severe depression||Most symptoms, and the symptoms markedly interfere with functioning. Can occur with or without psychotic symptoms|
Factors suggesting diagnosis of depression over dementia
Please note that due to the length of the 'quick' reference guide the following is a summary and we would advise you follow the link for more detail.
Persistent subthreshold depressive symptoms or mild to moderate depression with inadequate response to initial interventions, and moderate and severe depression
For these patients NICE recommends an antidepressant (normally a selective serotonin reuptake inhibitor, SSRI)
The following 'high-intensity psychological interventions' may be useful:
|Interpersonal therapy (IPT)||Delivery|
|Behavioural couples therapy||Delivery|
For people who decline the options above, consider:
- counselling for people with persistent subthreshold depressive symptoms or mild to moderate depression; offer 6-10 sessions over 8-12 weeks
- short-term psychodynamic psychotherapy for people with mild to moderate depression; offer 16-20 sessions over 4-6 months
For patients with chronic physical health problems the following should be offered:
- group-based CBT
- individual CBT