A joint statement by the Royal College of General
Practitioners (RCGP) and the Royal College of Psychiatrists
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
Depression can take many different forms, with
patients suffering a mix of physical, social and psychological
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
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
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
- Choice of treatment should depend on the severity of the
disorder therefore accurate assessment by the GP or psychiatrist is
Treatment options cover three broad types:
- self help treatments
- talking therapies
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
- for people with mild
depression, medication is generally not recommended and a
combination of self help and counselling may be most
- for people with moderately severe
depression, either medication, counselling or CBT is
- 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 an antidepressants
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.
Please note that we are unable to offer advice on individual cases. Please see our
advice on getting help.
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