13. CGA in Primary Care Settings: Patients presenting with depression

Good practice guide
Good practices guides focus on providing information on a clinical topic.
British Geriatrics Society
Date Published:
29 January 2019
Last updated: 
29 January 2019

Treatment for depression, as with any co-existing physical health problems, should be optimised. General advice should include good sleep hygiene, maintaining physical activity and limiting alcohol intake. 

  • For mild or subthreshold symptoms, psychosocial interventions such as increasing social contact and physical exercise may be sufficient.  Medication should not be offered as a first-line treatment but reserved for those who do not respond to initial measures.
  • When drug treatment is required, selective serotonin re-uptake inhibitor (SSRI) should be the first-line therapy. SSRIs may cause hyponatraemia, postural hypotension, and increase the risk of gastrointestinal bleeding.
  • Tricyclic antidepressants have anti-cholinergic side effects and should be avoided in older people.
  • Psychological therapies are effective in older people, and in combination with drug treatment are more effective than either therapy alone.
  • Those with moderate to severe symptoms are likely to require referral for specialist support.
  • People who have responded to medication should continue for at least six months after recovery to reduce the risk of relapse.
Further information

Treating depression in adults generally: NICE CG 90.

Treating depression in adults with long term health issues: CG91; See also an online learning module based around CG91: BMJ Learning.

Depression in older people: BMJ 2011: 343:d5219.

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