Common Mental Disorders Depression - New Zealand Doctor

Chapter 4 Management of depression in young people/rangatahi/tamariki
Severe depression
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 An urgent referral to specialist mental health services for assessment is also
indicated for a young person with severe depression. 66 In the opinion of the GDT,
persistent symptoms, profound hopelessness, severe functional impairment, or other
serious mental health or substance use disorders are factors that are likely to indicate
severe depression and the need for referral. Further information on determining severity
of depression and when to refer is included in Chapter 3: Recognition and Assessment
of Common Mental Disorders in Young People/Rangatahi/Tamariki. The practitioner
should be mindful also of culture-specific syndromes and, if concerned, consider liaison
with local iwi groups.
The young person/rangatahi/tamariki should also be actively monitored within primary
care, in order to maintain a therapeutic relationship and support treatment initiated in
secondary care.
The GDT notes that a strengths-based approach may be less feasible with a young
person/rangatahi/tamariki with severe depression, but once recovering they may
benefit from this type of model.
4.2 Specific interventions: review of the evidence
A systematic review of the literature was undertaken to identify RCTs on therapies for
depression for young people/rangatahi/tamariki in primary care. Given the dearth of
primary care studies, studies from secondary care included in the National Institute for
Health and Clinical Excellence (NICE) guideline (2005) 66 or highlighted by the GDT
were also considered.
Therapies of interest included:
• guided self-help
• exercise
• psychological therapies
• pharmacological therapies
• complementary and alternative medicines (CAMs).
Guided self-help
Guided self-help is defined, in this context, as the provision of psychological therapies
via written or IT-based materials. No evidence applicable to primary care was found.
Identification of Common Mental Disorders and Management of Depression in Primary Care 49