Dr Kola Tytler MBBS CertHE MBA MRCGPClinical Lead • iatroX
To effectively screen for comorbid conditions in adults presenting with depressive symptoms, a comprehensive assessment is crucial, moving beyond a simple symptom count NICE NG222,NICE CG91.
- Conduct a Comprehensive Assessment: Do not rely solely on a symptom count when assessing a person who may have depression NICE NG222,NICE CG91. Instead, take into account the severity of symptoms, previous history, duration, and course of illness, as well as the degree of functional impairment and/or disability associated with the possible depression NICE NG222,NICE CG91.
- Inquire About Coexisting Conditions: Discuss with the person any history of coexisting mental health or physical disorders NICE NG222. Specifically ask about any new symptoms of other mental health disorders, including anxiety, eating disorders, bipolar disorder, or psychosis NICE CKS.
- Assess for Bipolar Disorder: Always inquire about any history of mood elevation to determine if the depression may be part of bipolar disorder NICE NG222.
- Consider Chronic Physical Health Problems: Be particularly alert to possible depression in people with a past history of depression or a chronic physical health problem with associated functional impairment NICE NG222.
- Utilise Validated Measures: Consider using a validated measure (for example, for symptoms, functions, and/or disability) when assessing a person with suspected depression to inform and evaluate treatment NICE NG222. A validated depression questionnaire, such as PHQ-9, can be used to assess for depression, symptom severity, and response to treatment NICE CKS.
- Review Treatment Response: If there is no improvement in symptoms after 4 weeks of antidepressant medication or 4–6 weeks of psychological therapy, consider whether an alternative diagnosis or comorbid condition may be limiting the person's response to or engagement with treatment NICE CKS.
- Refer if Necessary: If, after initial depression identification questions, the practitioner is not competent to perform a mental health assessment, refer the person to an appropriate professional who can NICE NG222.