Depression in adults with a chronic physical health problem: recognition and management

National Institute for Health and Care Excellence


  • Depression is a broad and heterogeneous diagnosis, characterised by depressed mood and/or loss of pleasure in most activities. Severity of the disorder is determined by both the number and severity of symptoms and the degree of functional impairment (see Severities of depression)
  • This updated guideline uses the DSM-IV criteria for major depression (referred to here as ‘depression’) instead of the ICD-10 criteria used in NICE clinical guideline 23. Using DSM-IV enables specific interventions to be better targeted for more severe degrees of depression; its definition of severity also makes it less likely that a diagnosis will be made solely on symptom counting
  • Symptoms below the threshold for diagnosis can be distressing and disabling; therefore this updated guideline also covers ‘subthreshold depressive symptoms’ (see Severities of depression)

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