Page 64 - Depression in adults: treatment and management

Depression in adults: treatment and management (NG222)

1.10 1.10 Chronic depressive symptoms Chronic depressive symptoms

1.10.1 Be aware that people presenting with chronic depressive symptoms may not
have sought treatment for depression previously and may be unaware that they
have depression. Discussions about their mood and symptoms initiated by a
healthcare practitioner may help them access treatment and services. See the

visual summary on treatment for chronic depression. [2022] [2022]

1.10.2 For people who present with chronic depressive symptoms that significantly

impair personal and social functioning and who have not received previous
treatment for depression, treatment options include:

• CBT or or

• SSRIs or or

• SNRIs or or

• TCAs (be aware that TCAs are dangerous in overdose, although lofepramine has the
best safety profile) or or

• combination therapy with CBT and either an SSRI or a TCA.

Discuss the options with the person and reach a shared decision on treatment choice,
based on their clinical needs and preferences (see also the recommendations on choice
of treatments). [2022] [2022]

1.10.3 For people with chronic depressive symptoms, offer cognitive behavioural
treatment that:

• has a focus on chronic depressive symptoms

• covers related maintaining processes, including avoidance, rumination and
interpersonal difficulties. [2022] [2022]

1.10.4 For people who have had, or are still receiving, treatment for depression and
who present with chronic depressive symptoms, see the recommendations on
further-line treatment. [2022] [2022]

1.10.5 If a person with chronic depressive symptoms that significantly impair personal
and social functioning cannot tolerate a particular SSRI, consider treatment

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