Common Mental Disorders Depression - New Zealand Doctor

Chapter 4 Management of depression in young people/rangatahi/tamariki
Mild to moderate depression
A young person/rangatahi/tamariki with mild or moderate depression can generally
be treated using a psychosocial approach. A simple psychotherapeutic intervention
such as structured problem-solving therapy may also be beneficial.
The GDT recommends that initial management include active listening, identification of
current problems, discussion of simple self-management strategies and active monitoring.
The practitioner should encourage factors that promote resilience and social
competence, such as positive connections with a parent or other trusted adult,
involvement in community activities, and ‘required helpfulness’ (eg, chores and
responsibilities to the family or community). 170,171,253
Ideally, the young person/rangatahi/tamariki can be engaged in setting their own
treatment goals, which can be revisited or revised during follow-up. A plan for followup
should be agreed.
Two-weekly monitoring is recommended for most young people, but earlier or more
frequent contact may be required for some. Referral to support services, such as
school guidance counsellors or family services, should be considered. 66 Suicide risk
should be reassessed regularly. 162
The young person/rangatahi/tamariki should be fully reassessed at a face-to-face visit
at 2–4 weeks. 66 If there is no improvement in symptoms, the GDT recommends that the
practitioner offer intensified support. This should comprise an extended consultation
(eg, with the GP or practice nurse) to provide emotional support, active listening and
a review of the situation (eg, self-management strategies tried, depressive symptoms,
school/work attendance, suicidality and recent social activities). Although provision
of extended consultations can be difficult due to time and funding constraints, there is
growing evidence that longer consultations have the potential to improve mental health
outcomes. 261 A psychological intervention should also be offered at this stage.
The most feasible psychological intervention in a primary care setting is structured
problem-solving therapy. This can be delivered by a member of the primary care
team (eg, GP or practice nurse) with appropriate training and skill in working with this
age group: 4–6, 30-minute sessions over a 6–10-week period are suggested. 256,260
Structured problem-solving therapy is based on the principles of cognitive behavioural
therapy (CBT) and focuses on identifying and clarifying problems, setting realistic goals,
generating and implementing solutions and monitoring progress. This approach is well
supported by international expert opinion 256 though the research evidence is scant. 262
There is evidence to support the use of a course of formal CBT, interpersonal
psychotherapy (IPT) or behavioural activation (usually at least 6–8 sessions) for young
people with moderate depression, 262 but access to these therapies is very limited and
there is a strong need for increased availability in primary care. If referral to community
services, such as a school guidance counsellor or family services, has not already been
actioned, the option should be reconsidered at this stage. 66
Identification of Common Mental Disorders and Management of Depression in Primary Care 47