Identifying depression

The NICE Clinical Knowledge Summary on depression urges healthcare professionals to be alert to its possibility, particularly in those with a history of depression and in individuals who have a chronic physical health problem with associated functional impairment. A good starting point for identifying possible cases is asking the person about the two core symptoms: 

• During the last month have you often felt down, depressed or hopeless?
• Do you have little interest or pleasure in doing things?

If the answer is along the lines of “yes, most of the time, on most days, for at least two weeks”, the next step should be identifying the associated symptoms of depression:

• Disturbed sleep (more or less than usual)
• Change in appetite or weight (increase or decrease)
• Tiredness and low energy
• Agitation or slower than usual movements
• Poor concentration or indecisiveness
• Feelings of worthlessness or guilt
• Suicidal thoughts or acts. 

Identifying possible symptoms will give a sense of the severity of the depression and the degree of impairment in everyday functioning.

In younger sufferers the presentation may be slightly different. Symptoms may appear more anxiety-orientated and there may be behavioural changes – for example, being withdrawn, self-critical, apathetic or irritable; self-harming; or seemingly unrelated issues such as headaches or stomach pains, self-neglect, or a deterioration in school performance or attendance (see A teenager's perspective page). 

Anyone who seems to fit the criteria should be advised to contact their GP. If this is problematic, calling 111 or using the NHS 111 online service is an option. Referral to A&E or calling 999 is the best course of action in extreme circumstances for someone who doesn’t feel they can keep themselves or someone else safe. There is also a free listening service available via the Samaritans and a text crisis service provided by Shout.

Source: NICE CKS

Reflection exercise

Which of the apps recommended by the NHS do you think might be particularly useful for people with depression?