Both the 2009 and 2022 NICE guidelines offer two questions to start the conversation with a patient where depression is suspected:3,4
·       during the last month, has the person often been bothered by feeling down, depressed or hopeless?
·       during the last month, has the person often been bothered by having little interest or pleasure in doing things?
If the answer to either or both questions is yes, then the person should be referred to a GP or other practitioner capable of performing a mental health assessment. This should include their mental state, and associated functional, interpersonal and social difficulties.
The initial assessment should explore factors including:
·       any history of depression and coexisting mental health or physical disorders
·       any history of mood elevation (is bipolar disorder possible?)
·       any previous treatments
·       the impact on personal relationships
·       living conditions and behaviours (such as alcohol or drug use, employment and social isolation).
The assessment may also find anxiety symptoms are present, but treatment should usually address the depression first. Any management of anxiety should be along NICE guidelines for the relevant anxiety disorder.4