Common Mental Disorders Depression - New Zealand Doctor

Chapter 4 Management of depression in young people/rangatahi/tamariki
4.1 Clinical management
Approach to intervention
The goal of treatment for depression is to achieve remission, 255 with the intensity of
intervention adjusted in accordance with the young person’s response to treatment
(the ‘stepped care’ approach). 65 The Guideline Development Team (GDT) advises
using a combined risk-management and strengths-based approach. Comorbidities,
such as substance abuse, should be addressed concurrently, as in practice they often
improve with remission of depression. 54
It is feasible and appropriate for most young people/rangatahi/tamariki with
depression to be managed within primary care. 256,257 Interventions that can be
provided in this setting comprise a spectrum of therapies from advice and monitoring
to more intensive psychological therapies: in many cases a young person will respond
to a relatively simple intervention. 256
Evidence relating to specific interventions is presented in detail in later sections of this
chapter. When planning management, practitioners should consider symptom severity,
symptom persistence, functional impairment, response to any previous intervention
and also the wider psychosocial context, identifying factors that may impact positively
or negatively on outcome.
There is little evidence from randomised controlled trials (RCTs) of treatment of young
people in primary care to guide practice. Therefore the recommendations reflect
international and GDT consensus opinion.
Active support and monitoring
A collaborative relationship between the young person/rangatahi/tamariki and the
practitioner is a key component of treatment and improves the likelihood of a good
clinical outcome. 185,186 The practitioner should signal clearly that the disorder is a
significant issue requiring follow-up, and should provide information about depression,
treatment options, and an explanation of how to recognise signs of deterioration and
how to access help, if necessary.
Family/whänau and caregivers should be involved as much as possible, as this will
improve outcomes. 66,196 For young Mäori, recovery includes a cultural dimension that
is shaped around Mäori values, knowledge and social systems within the concept of
whänau ora (see Box 4.1). A secure cultural identity helps strengthen resilience to
mental disorder even in the presence of adverse socioeconomic conditions. 258
Identification of Common Mental Disorders and Management of Depression in Primary Care 45