13. CGA in Primary Care Settings: Patients presenting with depression

Treatment for depression, as with any co-existing physical health problems, should be optimised. General advice should include good sleep hygiene, maintaining physical activity and limiting alcohol intake. 

• For mild or subthreshold symptoms, psychosocial interventions such as increasing social contact and physical exercise may be sufficient.  Medication should not be offered as a first-line treatment but reserved for those who do not respond to initial measures.
• When drug treatment is required, selective serotonin re-uptake inhibitor (SSRI) should be the first-line therapy. SSRIs may cause hyponatraemia, postural hypotension, and increase the risk of gastrointestinal bleeding.
• Tricyclic antidepressants have anti-cholinergic side effects and should be avoided in older people.
• Psychological therapies are effective in older people, and in combination with drug treatment are more effective than either therapy alone.
• Those with moderate to severe symptoms are likely to require referral for specialist support.
• People who have responded to medication should continue for at least six months after recovery to reduce the risk of relapse.

Further information

Treating depression in adults generally: NICE CG 90.

Treating depression in adults with long term health issues: CG91; See also an online learning module based around CG91: BMJ Learning.

Depression in older people: BMJ 2011: 343:d5219.