Tuesday, 17 November 2009

Bedtime reading: NICE Guidance on Depression in CKD

Under-recognition of depression remains a major problem. As does the assessment of depression in the presence of chronic physical problems. NICE have issued a new guideline on depression focussing on adults with chronic physical health problems.

Kidney disease figures prominently in many sections of the report and the recommendations are highly relevant to the care of those with chronic kidney disease or recovering from acute kidney injury. I was struck on reading the guidelines of the parallels between depression in people with advanced kidney disease and acute kidney injury in acutely unwell patients. Both are common but often unrecognised, basic assessment of depression should be a core competency but often isn’t given prominence and when identified both are frequently mismanaged. The key message is to be alert to the possibility and questions to consider are:

“during the last month have you often been bothered by ‘feeling down’, depressed or hopeless?”
“during the last month have you been bothered by having little interest or pleasure in doing things?”

Depression in chronic physical conditions, including CKD is treatable. It is a major cause of avoidable morbidity, it prolongs length of stay and is independently associated with an increased risk of death. Read the full document (400 pages), quick reference guide or the excellent article in the BMJ (published on 27 Oct 09) by Stephen Pilling and colleagues on behalf of the guideline development group (Pilling et al. BMJ.2009; 339: b4108).

NICE have also produced guidance to promote mental wellbeing through productive and healthy working conditions that aims to help reduce the estimated 13.7 million working days lost each year due to work-related mental health conditions including stress, depression and anxiety. Sick leave in the NHS costs over £500,000,000 a year – staggering I know. David Nicholson, CEO of the NHS has highlighted this guidance to all his NHS Chief Executive colleagues because of its importance