In the meantime the April 2018 version of CG90 is the working document and sets out interventions depending on the level of depression. This is based on the DSM-IV classification system, rather than the ICD-10 classification, requiring five or more symptoms of depression to be present to be above the threshold.¹²

Priorities in CG90 (2018) include ensuring that people with subthreshold depressive symptoms which are persistent or those with mild to moderate depression are offered CBT, computerised CBT, or a structured group physical activity programme. This should be guided by the person’s own preference.

Antidepressants should not be used routinely for subthreshold depressive symptoms or mild depression, but could be considered where:

• There is a past history of moderate or severe depression
• Subthreshold symptoms have been experienced long-term, typically two years or more
• Symptoms persist after other therapy has been tried.

For moderate or severe depression, NICE recommends antidepressants in combination with a high-intensity psychological intervention (CBT or IPT).

To prevent relapse, antidepressant medication should continue for at least six months after remission. For those at significant risk of relapse, and where medication is not appropriate, individual CBT or mindfulness-based cognitive therapy is recommended.

Health professionals should be alert to the possibility of depression in a patient and may initiate a conversation. This could be by asking whether, during the last month, the person has often been bothered by feeling down, depressed or hopeless, or by having little interest or pleasure in doing things. General measures that can be mentioned include advising about sleep hygiene.