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Practice Guidelines

Depression in adults, including those with a chronic physical health problem: summary of NICE guidance

BMJ 2009; 339 doi: (Published 27 October 2009) Cite this as: BMJ 2009;339:b4108
  1. Stephen Pilling, joint director1, professor of clinical psychology and clinical effectiveness2,
  2. Ian Anderson, professor of psychiatry3,
  3. David Goldberg, professor emeritus4,
  4. Nicholas Meader, systematic reviewer5,
  5. Clare Taylor, editor5,
  6. On behalf of the two guideline development groups
  1. 1National Collaborating Centre for Mental Health, University College London, London WC1E 7HB
  2. 2Research Department of Clinical, Educational and Health Psychology, University College London, London WC1E 7HB
  3. 3University of Manchester, Manchester M13 9PL
  4. 4Institute of Psychiatry, King’s College London, London SE5 8AF
  5. 5National Collaborating Centre for Mental Health, Royal College of Psychiatrists’ Research and Training Unit, London E1 8AA
  1. Correspondence to: S Pilling s.pilling{at}

    Why read this summary?

    Each year 6% of adults will experience an episode of depression, and over the course of a person’s lifetime more than 15% of the population will have an episode.1 2 3 4 Depression (as defined by the American Psychiatric Association5) is the leading cause of suicide and currently the fourth highest disease burden on society in terms of its treatment costs, its effect on families and carers, and its impact on productivity in the workplace.

    Depression can be disabling and distressing and for many people can become a chronic disorder, especially if inadequately treated. It is about two to three times more common in people with a chronic physical health problem than in people who are in good physical health.6 Chronic physical health problems can precipitate and exacerbate depression, but depression can also adversely affect outcomes of coexisting physical illnesses, including increased mortality. Furthermore, depression can be a risk factor for some physical illnesses, such as cardiovascular disease.7

    This article summarises the most recent recommendations on depression from the National Institute for Health and Clinical Excellence (NICE): an updated guideline on the management and treatment of depression in adults8 and a new guideline on depression focusing on adults with a chronic physical health problem.9 In both guidelines diagnosis was based on the criteria of the Diagnostic and statistical manual of mental disorders, fourth edition (DSM-IV), which require the presence of at least five symptoms and of impaired function persisting for at least two weeks.5


    NICE recommendations are based on systematic reviews of the best available evidence. When minimal evidence is available, recommendations are based on the experience and opinion of the Guideline Development Group (GDG) of what constitutes good practice. Evidence levels for the recommendations are given in italic in square brackets. …

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