March 2008
Summary
One in every six adults
is affected by depression and anxiety - by 2020 it is estimated
that depression will be the second most common disabling condition
in the world.
Depression can take many
different forms, with patients suffering a mix of physical, social
and psychological problems.
Identifying and providing
the most suitable treatment for people with these common mental
health problems can be a difficult and complex process for health
professionals.
GPs and their practice
teams and specialist mental health services need to work together
to ensure that patients receive the highest quality advice and
access to care and appropriate services.
Identification of People with Anxiety and Depression
Physical symptoms are often the first sign that people are
suffering from depression or anxiety. They might go to their
GP or another member of the GP practice team saying they have a
pain, are tired or are feeling unwell for some unexplained
reason.
Understanding what the
symptoms mean to the patient and establishing whether they relate
to a physical illness or a mental health problem - or both - can be
a complicated task, frequently needing more than one
consultation.
Diagnosis of depression
or anxiety is neither quick nor easy and should always involve the
patient, taking their views and expectations into
account.
The National Institute
for Health and Clinical Excellence (NICE) guidelines published in
2004 have been very useful in helping doctors recognise and
accurately diagnose the presence - or absence - of a
number of key symptoms and signs of common mental health problems
during consultations with patients.
Providing Treatment Advice
The NICE Guidelines also
provide advice on how people who are suffering from a common mental
health problem should be treated and cared for. Although
depression and anxiety may be different disorders, they can
co-exist.
Advice in the guidelines
is clear and precise on a number of issues:
- People need to be given information about their condition and
the treatments that could be effective.
- Treatments are more likely to be effective if the person
receiving the treatment is involved in the decision process and has
an opportunity to say what sort of treatment they would prefer, or
particularly not want. (Where people are currently receiving or
have previously been on treatment, it is most important to find out
about their experience and whether they feel it has been
beneficial)
- Choice of treatment should depend on the severity of the
disorder therefore accurate assessment by the GP or psychiatrist is
essential
Treatment Options
Treatment options cover
three broad types:
- self help treatments
- talking therapies
- medication
People with depression
and anxiety may be experiencing difficult and stressful life
circumstances such as housing, financial or relationship
difficulties so it might be useful to pinpoint other sources of
support such as local authorities and social services.
Self Help treatments -
these include bibliotherapy (book therapy); computerised cognitive
behaviour therapy (CBT); exercise on prescription and lifestyle
changes such as reducing alcohol and dietary changes.
Information should be readily available at GP practices for
patients who may choose this treatment.
Talking therapies -
include counselling, psychotherapy and cognitive behaviour
therapy. GPs teams should know how to access such types of
therapy in their local area and how to help patients decide what
may or may not be helpful for their individual needs.
Medication - NICE
recommends a selective serotonin re-uptake inhibitor (SSRI) as a
first drug for depression. For patients with general anxiety
and panic, NICE also makes a similar recommendation – that an SSRI
should usually be the first choice where medication is
appropriate.
The NICE guidelines for
depression make clear that the treatments offered should always
depend on the severity of the disorder:
– for people with
mild depression, medication is generally not recommended and a
combination of self help and counselling may be
most appropriate
– for people with
moderately severe depression, either medication, counselling or CBT
is
appropriate
– for people with severe
depression, it is likely that both CBT and medication will be
beneficial and
so they
should be offered both.
– for patients with
generalised anxiety disorder and panic disorder, self-help, talking
therapies and
medication
are equally effective. In the first instance, the choice of
treatment should be at the
discretion
of the patient in discussion with their doctor.
It is clear there should
be a range of treatments, including medication, available for
people with depression and anxiety. Patients
should not have to choose between medication or nothing.
The advice that somebody
with depression or anxiety will receive from their doctor, (GP or
psychiatrist) should depend on their personal circumstances, their
past history (including what has worked well before, if
appropriate), and on the informed discussion between patient and
health professional.
Advice if you are already taking
anti-depressants
Do not suddenly stop
taking the medication. You should arrange a non-urgent appointment
(or telephone call) to speak to the doctor who is prescribing for
you. At that consultation you can agree with the GP or
psychiatrist if it is appropriate for you to continue or to stop
the medication.
It is worth remembering
that if you are one of the many people for whom antidepressants
have been - and continue to be - effective, you are likely to need
to take the medication for up to six months after the depression or
anxiety has been resolved and you should consider this in making
your decision.
For more information please contact
the RCGP press office 020 7344 3135/3136/3137/3129 or
email press@rcgp.org.uk