This guideline covers:

• identification, recognition and assessment of depression in patients with chronic physical health problems, including variations to the assessment to take account of the needs of people with learning difficulties, acquired cognitive impairments or language difficulties
• treatment of depressive episodes of differing severity, including the appropriate use of psychosocial interventions (such as guided self-help, formal psychological interventions, support groups and programmes aimed at facilitating employment), pharmacological interventions (including antidepressants and other medication), and physical interventions (such as exercise or electroconvulsive therapy)
• variations to the systems for accessing and delivering treatment required to take account of the needs of people with learning difficulties, acquired cognitive impairments or language difficulties
• interventions to reduce the risk of relapse after an acute depressive episode
• assessment and management of known side effects and other disbenefits of psychotropic medication, physical interventions and psychosocial interventions, including long-term side effects and risks of suicide
• combined psychosocial and pharmacological treatments, the use of combined pharmacological treatments and the sequencing of both pharmacological and psychosocial interventions
• the safe withdrawal or discontinuation of psychotropic medication
• interactions between psychotropic medication and prescription and over-the-counter drugs commonly used for the relevant comorbid physical disorder
• the varying approaches of different races and cultures, and issues of internal and external social exclusion
• ensuring that people with depression and chronic physical health problems have the information they need and the opportunities to discuss with their clinicians the advantages, disadvantages and potential side effects of treatment so that they can make informed choices about the options for their care
• the role of families and carers in the treatment and support of people with depression and chronic physical health problems
• how services are delivered, including models of care such as case management and collaborative care, and the structured delivery of care in primary and secondary care services
• note that guideline recommendations for pharmacological interventions will normally fall within licensed indications; exceptionally, and only if clearly supported by evidence, use outside a licensed indication may be recommended. The guideline will assume that prescribers will use a drug's summary of product characteristics to inform their decisions made with individual service users
• the guideline development group will take reasonable steps to identify ineffective interventions and approaches to care. If robust and credible recommendations for repositioning an intervention for optimal use or changing an approach to care to make more efficient use of resources can be made, they will be clearly stated. If the resources released are substantial, consideration will be given to listing such recommendations in the ‘Key priorities for implementation’ section of the guideline
  
  

This guideline does not cover:

• diagnosis of depression or comorbid disorders
• primary prevention of depression or comorbid disorders