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DEPRESSION The underlying cause of depression is unknown, but is likely to…

- - - - Consider a diagnosis of depression if a person has possible risk factors, non-specific symptoms, or any of the symptoms of depression listed below.
      - Be aware that a person with depression may present with non-specific symptoms rather than low mood.
      - In particular, older people may only present with physical symptoms or a deterioration in cognitive functioning.
      - Ask the two 'depression identification questions':
      - During the last month, have you often been bothered by feeling down, depressed, or hopeless?
      - During the last month, have you often been bothered by having little interest or pleasure in doing things?
      - If the person answers 'yes' to one of the questions and symptoms have been present most days, most of the time, for at least 2 weeks, ask about associated symptoms of depression:
      - Disturbed sleep (decreased or increased compared to usual). See the CKS topic on Insomnia for more information.
      - Decreased or increased appetite and/or weight.
      - Fatigue or loss of energy. See the CKS topic on Tiredness/fatigue in adults for more information.
      - Agitation or slowing down of movements and thoughts.
      - Poor concentration or indecisiveness.
      - Feelings of worthlessness or excessive or inappropriate guilt.
      - Recurrent thoughts of death, recurrent suicidal ideas, or a suicide attempt or specific plan. See the CKS topic on Self-harm for more information.
- - - - treatment options and self help
        
        The Royal College of Psychiatrists (RCPsych) — website www.rcpsych.ac.uk; provides patient information including Depression in adults; Depression in Older Adults, Sleeping well, Alcohol and Depression, Antidepressants, and Cognitive Behavioural Therapy (CBT).
        
        MIND — website www.mind.org.uk;
        
        Provide advice on the nature and course of depression, recovery, and sources of information and support including self-help materials, support groups, and peer support
        
        Depression UK — website www.depressionuk.org;
        
        https://cks.nice.org.uk/topics/depression/prescribing-information/
        
        Mental Health Foundation — website www.mentalhealth.org.uk;
        
        The Samaritans — website www.samaritans.org;
        
        SANEline — website www.sane.org.uk;
        
        BEING PROACTIVE
        
        Provide advice on activities to improve sense of wellbeing, such as:
        
        Physical activitity including walking, jogging, swimming, dance, gardening, particularly if outdoors.
        
        Maintaining a healthy lifestyle through diet, alcohol intake, and sleep.
        
        Offer social support including for any family and/or carers who are supporting the person
        
        Arrange urgent referral to specialist mental health services if the person has: Severe depression or self harm
        
        https://cks.nice.org.uk/topics/depression/management/initial-management/#initial-management
        
        Follow local safeguarding procedures if: there are vulnerable people or children under their care