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The Royal College of Psychiatrists Improving the lives of people with mental illness

 

A joint statement by the Royal College of General Practitioners (RCGP) and the Royal College of Psychiatrists (RCPsych)

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 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.

March 2008

 

Please note that we are unable to offer advice on individual cases. Please see our FAQ for advice on getting help.

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