UK nice guidelines for depression in people with a chronic physical illness

Abstract

The UK National Institue of Clinical Excellence development group performed a systematic review to determine the efficacy of pharmacological and non-pharmacological treatments for depression in people with depression and chronic physical health problems. The primary outcome of interest was depression.61 studies of antidepressants met our inclusion criteria. Of non-pharmacological RCTs 33 met our inclusion criteria and 21 were meta-analysed. Antidepressants appear to be effective and reasonably well-tolerated in the treatment of depression occurring in the context of chronic physical illness. No particular drug or drug group is preferred, although SSRIs may be better tolerated than TCAs and have a clear benefit on quality of life. Despite clinical concerns over adverse effects and drug interactions, antidepressants should not be withheld in the treatment of depression associated with chronic physical illness. For non-pharmacological treatments, the largest and strongest evidence base supports individual- and group-based cognitive and behavioural interventions (18 trials). The evidence was strongest for those interventions aimed at reducing depression in comparison to those aimed at reducing psychosocial stress. There is also some support for peer (self-help) support and guided self-help interventions based on cognitive and behavioural principles. Overall, the efficacy of pharmacological and non-pharmacological interventions for people with depression and chronic physical health problems is comparable to their efficacy in people with depression without chronic physical health problems. They should be used more widely.