Practice Nursing 2009, Vol 20, No 4 199 D epression is a major public health problem. Up to one in ten adults may be suffering from depressive symptoms, and the World Health Organization (WHO) (2008) estimates that, globally, by 2020 depression will be the second greatest cause of disability. The importance of recognizing depression in general practice has been acknowledged in the Quality and Outcomes Framework (QOF) of the new GMS contract (Table 1). The GMS contract also includes payments for the National Enhanced Services (NES), one of which relates to the specialized care of patients with depression. Defining depression When people are depressed they feel down most of the day, are not interested in what is going on around them and get very little pleasure out of life. Some of the other com- mon symptoms of depression include a lack of energy or feeling tired all the time, a loss of self-confidence, thoughts about wanting to die, difficulty thinking or concentrating, sleeping more or less than usual, and not being interested in sex (American Psychiatric Association (APA), 2000). The severity of depression people experience varies greatly and is best considered as a continuum rang- ing from minimal to severe (Anderson et al, 2008). Although depression most commonly develops in early adulthood (20–45 years), it can occur throughout people’s lives. Depression is up to two and a half times more common in women than men; about 7% of the population will experience moderate to severe depression at some point during their lives (Waraich et al, 2004). Groups that appear to be at high risk of depression include separated men and women, widowed men and divorced women. Other factors that increase the risk of depression include: Parkinson’s disease where depression is common but often unrecognized Dementia where the two illnesses have similar symptoms that can be difficult to separate ➤ ➤ After pregnancy, where depression occurs in up to 11% of women (O’Hara, 1997) Alcoholism and substance misuse where it may be unclear if the depression is the cause or effect Forms of physical abuse, past or present Physical illnesses including cancer, cardio- vascular disease, stroke and diabetes Chronic pain Stressful life events Ageing Unemployment Homelessness. Depression is an illness that can be treated, regardless of the age of the patient. Seven out of ten people will respond to treatment with either antidepressant medication, cognitive behavioural therapy (CBT), or a combination of the two (National Institute for Health and Clinical Excellence (NICE), 2007). However, depression is toxic if left untreated and can evolve into a long-term episodic condition that can be challenging and expensive (both to the health service and society) to effec- tively treat. In our society, widespread ignorance as to the causes of depression has stigmatized the illness, so that it is frequently perceived as a sign of personal weakness. As a consequence, ➤ ➤ ➤ ➤ ➤ ➤ ➤ ➤ ➤ Treatments and issues of choice in depression Richard Gray is professor of research relating to nursing at the University of East Anglia, Michael Pfeil is senior lecturer at the University of East Anglia and Martin Jones is associate director of nursing at Surrey and Borders Foundation NHS Trust and honorary senior lecturer at the University of East Anglia Submitted for peer review 7 October 2008 accepted for publication 14 November 2008 Key words: Depression, treatment, side effects Richard Gray, Michael Pfeil and Martin Jones explain how to recognize depression and treat it according to patients’ needs Clinical MENTAL HEALTH Payment Indicator Pts stages Diagnosis and initial management DEP 1: The percentage of patients on the diabetes register and/or the CHD 8 40–90% register for whom case finding for depression has been undertaken on one occasion during the previous 15 months using two standard screening questions (not via postal questionnaire) DEP 2: In patients with a new diagnosis of depression, recorded between 25 40–90% the preceding 1 April to 31 March, the percentage of patients who have had an assessment of severity at the outset of treatment using an assessment tool validated for use in primary care DEP 3: In those patients with a new diagnosis of depression and assessment of 20 40–90% severity recorded between the preceding 1 April to 31 March, the percentage of patients who have had a further assessment of severity 5–12 weeks (inclusive) after the initial recording of the assessment of severity. Both assessments should be completed using an assessment tool validated for use in primary care From: British Medical Association and NHS Employers, 2009. Table 1. QOF depression indicators 2009/2010