NHG-Standaard Depressie (tweede herziening)

Van Weel-Baumgarten EM, Van Gelderen MG, Grundmeijer HGLM, Licht-Strunk E, Van Marwijk HWJ, Van Rijswijk HCAM, Tjaden BR, Verduijn M, Wiersma Tj, Burgers JS, Van Avendonk MJP, Van der Weele GM. The NHG guideline Depression (second revision of the NHG guideline Depressive disorder) ). Huisarts Wet 2012;55(6):252-9. This revision provides guidelines for the management of adults with depressive symptoms or depression. Depressive symptoms are included in addition to depression because general practitioners see patients with depressive symptoms more often than they see patients with depression, and doctors need diagnostic and therapeutic advice about these patients. Moreover, there is increasing evidence that the nonpharmacological treatment of depressive symptoms by general practitioners is effective. Low mood or depressive symptoms are often a normal, transient reaction to disappointment or loss. The patient is bothered by these symptoms but they are not severe enough to meet DSM-IV criteria for depression. Depression is characterized by depressed mood and/or a pronounced loss of interest or pleasure in almost all activities. At least five DSM-IV symptoms, including one core symptom, need to be present for at least 2 weeks. DSM-IV core symptoms are depressed mood and loss of interest or pleasure in all activities for most of the day, every day. Other symptoms are marked loss of weight or weight gain; insomnia or hypersomnia; psychomotor agitation or inhibition; fatigue or loss of energy; low self-esteem or excessive feelings of guilt; diminished ability to think/concentrate and indecisiveness; recurrent thoughts of death, suicidal thoughts, or attempted or planned suicide. The diagnosis should preferably be made in a systematic, process-related manner over the course of several visits and within a good doctor–patient relationship. With regard to treatment, it is important to distinguish between depressive symptoms and depression. Winter depression and postpartum depression are distinguished as subtypes of depression. Dysthymia is characterized by the presence of depressive symptoms for at least 2 years. Treatment of depression is dependent on its severity, based on the number of DSM-IV symptoms, the severity of suffering and social dysfunctioning, and the potential presence of psychiatric comorbidity. The higher the number of unfavourable factors that are present, the more severe the depression; however, there is no cut-off because symptoms are on a continuum. Effective management is dependent upon the patient’s willingness to undergo treatment and to take joint responsibility for his recovery. The first step in the treatment of depressive symptoms is to provide the patient with information; patients with persistent depressive symptoms or depression can be offered help to structure their daily life and a short course of psychological treatment. If this proves ineffective in patients with depression, psychotherapy or an antidepressant is recommended. However, psychotherapy and antidepressant treatment should be started from the outset if depression is accompanied by severe suffering or social dysfunctioning or severe psychiatric comorbidity. While serotonin re-uptake inhibitors (SSRIs) and tricyclic depressants are similarly effective, in general SSRIs have a slightly more favourable side-effect profile and are the preferred agents. If the response is good, treatment should preferably be continued for at least 6 months. It is important to monitor the course of depressive symptoms or depression during treatment. Patients who are recovering should be supported during antidepressant discontinuation (if appropriate) and attention should be paid to relapse prevention. Immediate referral to secondary care is indicated if there is a suicide risk, bipolar disorder or psychotic characteristics, postpartum depression with psychotic characteristics or inadequate care of the child, or recurrent depression with severe social dysfunctioning or suffering or psychiatric comorbidity. aandoening, functionele beperkingen en gebrek aan sociale steun. Het recidiefpercentage van depressie is 35 tot 65%. Depressie kan een oorzaak zijn van langdurige arbeidsongeschiktheid. Richtlijnen diagnostiek Denk aan een depressie bij patienten