1. Guidelines for depression in palliative care WP 3.2 : EPCRC : Trondheim Irene Higginson, Alison Evans, Matthew Hotopf

2. Overview of progress other reviews / guidelines identified expert group formed Cochrane systematic review underway: “Antidepressants for depression in physically ill people” future systematic reviews identified http://www.kcl.ac.uk/palliative

3. Research group Irene Higginson, Kings College London (lead) Matthew Hotopf, Kings College London Jon Håvard Loge, Trondheim University of Science and Technology Augusto Caraceni, National Cancer Institute of Milan Lukas Radbruch, University of Aachen Annabel Price, Kings College London Alison Evans, Kings College London http://www.kcl.ac.uk/palliative

4. Clinical guidelines for management of depression registered as stakeholder for National Institute for Clinical Excellence (England and Wales) updates: - depression in primary and secondary care - depression in chronic health problems (not including palliative care) guidelines from Germany and the Netherlands antidepressants in palliative care (Lawrie et al, 2006) http://www.kcl.ac.uk/palliative

5. Formation of expert group list of roles selected experts invited expert nominations sought via: - EAPC board - national / regional European palliative care associations in Europe - EAPC website - other contacts http://www.kcl.ac.uk/palliative

6. Role of expert group complete questionnaire on current practice / describe response to given scenarios discuss suggested clinical guideline for management of depression review colleagues’ comments on guideline suggest relevant research literature not detected discuss revised guideline using Delphi technique take part in finalisation of guideline http://www.kcl.ac.uk/palliative

7. Top level questions effectiveness of antidepressants for treatment of depression in palliative care and physical illness - Cochrane review of RCTs underway effectiveness of non-pharmacological treatment - Cochrane review of RCTs to be registered PLUS systematic review of non-RCT evidence http://www.kcl.ac.uk/palliative

8. Limited evidence in palliative care Ly, Hotopf et al (2002) - RCTs of interventions for depression in patients with advanced disease - 3 RCTs on pharmacological treatments - no non-pharmacological treatments met criteria “quick and dirty” search of EMBASE, MEDLINE, PsychINFO (2000 to present) - 2 RCTs on pharmacological treatments - 13 on non-pharmacological treatments http://www.kcl.ac.uk/palliative

9. Cochrane review: antidepressants in physical illness http://www.kcl.ac.uk/palliative search of Cochrane register of trials - diagnosis of depression - antidepressants as intervention - placebo controlled - comorbid diagnosis 99 studies identified

10. Screening for Cochrane review Participants adults (18 and over) physical illness and co-existing depression definition of depression: specific scale/test antidepressants primarily to treat depression Interventions antidepressant vs placebo Primary outcome measure change in depression measured by valid tool http://www.kcl.ac.uk/palliative

11. Cochrane review: QUOROM chart http://www.kcl.ac.uk/palliative Potentially relevant RCT studies identified from Cochrane trials register (n = 99) RCTs excluded (n = 27) RCTs in screening process (n = 24) RCTs under review (n = 48)

12. Next steps http://www.kcl.ac.uk/palliative complete Cochrane review of antidepressants register review of non-pharmacological treatments with Cochrane and commence draw up proposals for EPCRC website

13. Milestones March 2007: expert group constituted November 2007: proposals published on web for consultation and evidence submission July 2008: results of systematic reviews published November 2008: revised proposals available on web for consultation November 2009: final guidelines published on web http://www.kcl.ac.uk/palliative