Common Mental Disorders Depression - New Zealand Doctor

Chapter 6 Management of depression in adults/pakeke
Good practice points
continued...
Management of depression in adults
A practitioner managing an adult with severe depression in primary
care needs to have easy access to consultation with a psychiatrist
First-line treatment for an adult with melancholic depression is a
tricyclic antidepressant
If an adult on antidepressant medication has had no or minimal
response after 3–4 weeks, or if side effects are unacceptable, review
the treatment plan and consider changing to a different antidepressant,
or changing to or adding a psychological therapy
If an adult with mild depression does not respond to supportive
treatment (psychosocial support and self-management strategies)
within 2–4 weeks (ie, ≥50% reduction in symptoms) the patient and
practitioner should review the treatment plan and consider intensifying,
changing or augmenting measures taken to date
The primary care team should include members skilled in conducting
brief psychological interventions for depression
Psychological therapies offered should use a recognised therapeutic
approach which targets depression and related problems and which
focuses on resilience and behavioural support
Opinion of the Guideline Development Team, or feedback from consultation within New Zealand
where no evidence is available
6.1 Clinical management
Approach to intervention
Most adults/pakeke with depression can be treated within primary care. 65 The goal of
treatment is to achieve remission of symptoms 255 and prevent relapse or recurrence. 143
The intensity of intervention should be determined by the severity of depression
and adjusted in accordance with patient response (the ‘stepped care’ approach). 65
Comorbidities should be addressed concurrently: in practice they may improve with
remission of depression. 330
Interventions for depression in adults comprise a spectrum of therapies, from exercise
and self-management to psychological therapies (of varying length and intensity) and/
or antidepressants. 65 The evidence relating to specific interventions is presented in
detail in later sections of this chapter.
Identification of Common Mental Disorders and Management of Depression in Primary Care 69