Depression
- Treatment

General principle

• Step 1: Assess if DSM-IV is met
• Step 2: Rule out substance abuse/medical condition/other psych disorder
• Step 3: Assess functional impairment, risk, social support
• Step 4: Consider admission if high risk, poor support, severe function impairment, or psychosis

 

If psychotic features present, consider electroconvulsive therapy (ECT) or combination of antidepressant and antipsychotic medication

 

Mild depression -> Treat with counselling or psychotherapy

Severe depression -> Treat with antidepressant and perhaps counselling and psychotherapy

 

A delay in onset of antidepressant response of at least 1 to 2 weeks occurs with all antidepressant.

Full recovery (in those who do respond to the drug) may take up to 6 weeks or longer.

Antidepressant should be continued for at least 6 months and up to 12 months.

 

First-line therapy

Selective serotonin reuptake inhibitors (SSRIs)

Moclobemide

Nefazodone

Venlafaxine

 

Second-line therapy

Tricyclic antidepressants

Mianserin

Irreversible non-selective monoamine oxidase inhibitors