Based on NICE Guideline NG222: “Depression in adults: treatment and management”
Depression is more than just feeling sad. It’s a common and serious medical illness that negatively affects how you feel, the way you think, and how you act. In a clinical setting, particularly primary care, recognizing its signs is the first crucial step toward helping a patient. This guide, based on NICE guidelines, provides a structured overview for students learning to identify, assess, and manage depression in adults.
Test your knowledge! Select a severity level and a context to instantly generate a realistic patient vignette. Analyze the scenario and consider the appropriate next steps in the Stepped-Care Model.
The Patient Health Questionnaire-9 (PHQ-9) is a primary tool used to screen for depression and assess its severity. The total score, based on 9 questions, guides clinical decision-making. This chart illustrates the score ranges corresponding to each severity level.
For a formal diagnosis, clinicians use criteria from manuals like DSM-5 or ICD-10. According to DSM-5, a patient must have five or more symptoms during the same 2-week period, representing a change from previous functioning. At least one must be:
Plus three or more of the following:
NICE guidelines recommend a “stepped-care” model. This means patients are offered the least intrusive, most effective intervention first, “stepping up” to more intensive treatments only if needed. This optimizes resources and tailors care to individual severity.
Assessment, support, psychoeducation, and “watchful waiting” or active monitoring.
Low-intensity psychological interventions (e.g., guided self-help, computerized CBT), physical activity programs.
Choice of: High-intensity psychological intervention (e.g., CBT, IPT) OR an antidepressant (SSRI like Sertraline).
Specialist mental health services. May involve crisis teams, combination therapies (meds + CBT), or ECT.
Assessment, support, psychoeducation, and “watchful waiting”.
Low-intensity psychological interventions (e.g., guided self-help, cCBT).
High-intensity psychological intervention (e.g., CBT) OR an antidepressant (SSRI).
Specialist mental health services, combination therapies, ECT.
Depression is significantly more common in people with chronic physical health problems and can worsen their outcomes. Recognizing and managing co-morbid depression is vital. This chart shows estimated prevalence rates in common conditions compared to the general population.
A core part of any depression assessment is a risk assessment. You must ask directly about thoughts of self-harm and suicide. If risk is identified, follow local protocols for urgent referral or safety planning.
When antidepressants (like SSRIs) are started, follow-up is critical.
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