Common Mental Disorders Depression - New Zealand Doctor

If the young person/rangatahi/tamariki reports deterioration in symptoms at 2–4 weeks,
the GDT recommends that either treatment be intensified (as above) or they be referred
to secondary care mental health services, depending on the severity of symptoms.
If the young person/rangatahi/tamariki is referred for formal counselling, in the
opinion of the GDT, the counsellor should use a recognised therapeutic approach
which targets depression and focuses on resilience and behavioural support (eg, CBT,
IPT, behavioural activation) and should have training and expertise in working with
the relevant age group. Counselling should also address any trauma that may have
precipitated the depression. 263 The young person/rangatahi/tamariki should continue
to be monitored by a member of the primary care team, in order to maintain the
therapeutic relationship.
If the young person/rangatahi/tamariki does not report substantial improvement
after 6–8 weeks of treatment, they should be referred to secondary care mental
health services. 66
Antidepressant treatment should not be initiated in a young person/rangatahi/tamariki
in primary care except in consultation with a child and adolescent psychiatrist, in
accordance with Medsafe advice. 264 Specialist advice should also be sought before
changing or stopping antidepressant therapy in this population. 264,265 During the
initial few months of antidepressants treatment or at times of dose increase or
decrease, the family/whänau and caregivers of a young personrangatahi/tamariki
on antidepressants need to be aware of the importance of seeking help from a health
care provider if they notice any symptoms of agitation, irritability or unusual changes
in behaviour. Such symptoms are thought to be precursors of emerging suicidality. 66
The GDT notes that a young person who reports improvement with treatment
in primary care should be proactively monitored 1–2 monthly until they have a
satisfactory response to treatment, defined as remission of symptoms and return to
normal function. Monitoring may consist of phone, email, text or face-to-face contact.
The practitioner should ensure that a young person has an action plan to use if
symptoms recur at any stage (ie, what to look out for, what to do and who to contact).
See Appendix F: Self-management Resources for links to a self-management resiliency
tool with a focus on relapse prevention strategies.
A young person/rangatahi/tamariki with serious suicidal intent, psychotic symptoms
or severe self-neglect should be referred immediately to secondary care mental
health services. 66 Steps should be taken to ensure the safety of the young person
while the referral is actioned and there should be regular reassessment of risk.
The family, whänau and others should be advised of the need for close observation,
and to remove potential suicide means, such as obvious ligature points, firearms
and toxic substances (including unnecessary medications) from the household. 127
Those supporting the young person/rangatahi/tamariki while awaiting entry to
secondary services should be made aware of the fact that alcohol intoxication
may increase suicide risk. 266
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Identification of Common Mental Disorders and Management of Depression in Primary Care