Treatment
Inital assessment,
screening questions
Various factors must be taken into consideration when treating depressed patients. The severity of depression essentially dictates the treatment regime and whether or not pharmacological, non-pharmacological or both interventions are required. It is important to correctly identify at which stage the patient is as to avoid misdiagnosis and in some situations, prevent serious harm to the affected indivual or others. NICE have developed a stepped care model for the management of depression in primary and secondary care (Table below) , as a guide for practitioners. As the severity of depressive symptoms increase, the care and treatment is adjusted to treat the individual effectively.
Mild psychosocial and psychological interventions. Watchful waiting, sleep and anxiety management, exercise, guided self-help, CBT, counselling, medication and follow up.
Intense psychological interventions, medication, monitoring, continuation of treatment , combined therapy
High intensity psychological interventions, Electroconvulsive Therapy, inpatient care, combined therapy
1
2
3
4
GP, primary care nurse
Specialist mental health services, CRISIS team
Primary care team, or hospital settings
Primary care team, or hospital settings
Recognition of depressive symptoms at this stage
MIld to moderate
MIld to moderate or severe depression
Severe and complex depression. Treatment resistant depression, accompanied by psychotic symptoms
Follow the links to gain some more in depth knowledge of the treatment inteventions.