title: Tackling depression in patients with chronic conditions.
abstract: Compared with the general population, patients with a chronic physical health problem are two to three times more likely to be depressed. Their depression is less likely to be recognised and they are less likely to accept and tolerate antidepressant treatment. Comorbid depression is associated with increased pain, greater functional impairment and reduced quality of life. Depressed patients may lack confidence to self-manage their condition, increasing the risk of long-term complications. The new NICE guidance on depression in adults with a chronic physical health problem recommends a shift of emphasis from screening to identification. We should be alert to the possibility of depression in high-risk patients and consider using the two question screen. When used in this way, its main value is in ruling out depression. The DSM-IV definition of depression can lead to overdiagnosis in patients with a chronic condition, if somatic symptoms are caused by the illness, rather than depression. One proposed solution is to simplify the diagnostic criteria by restricting these to the five psychological symptoms. Three symptoms would then be needed for a diagnosis.
authors.forename: Phillip
authors.initials: P
authors.lastname: Bland
mesh_terms: D000328:Adult; D000928:Antidepressive Agents / Q000627:therapeutic use; D002908:Chronic Disease / Q000523:psychology*; D003866:Depressive Disorder / Q000150:complications / Q000628:therapy; D006801:Humans; D011613:Psychotherapy / Q000379:methods; D012017:Referral and Consultation
chemical_list: D000928:Antidepressive Agents