management of depression

Last edited 08/2018 and last reviewed 01/2023

The management of depression is comprised of:

• social interventions:
• day centres
• self-help
• hospital admission

• physical interventions:
• antidepressant drugs
• electroconvulsive therapy
• in rare cases, surgery

• psychological interventions

Iindications for antidepressants are (1):

• in cases of major depression, antidepressants are a first line treatment irrespective of environmental factors. At the mildest severity of major depression the benefit is uncertain
• in cases of dysthymia, antidepressants are a first line treatment
• in acute milder depression at initial presentation:
• treatment with antidepressants is not indicated
• support, education and simple problem solving are recommended
• the patient should be monitored for persistence and for the development of major depression
• in persistent milder depression, a trial of antidepressants is recommended
• if milder depression with a history of major depression then consider treatment with antidepressants

When depressive symptoms are accompanied by anxious symptoms, the first priority should usually be to treat the depression (2):

• when depression is accompanied by symptoms of anxiety, the first priority should usually be to treat the depression
  • however when the person has an anxiety disorder and comorbid depression or depressive symptoms, consult the NICE guideline for the relevant anxiety disorder and consider treating the anxiety disorder first (since effective treatment of the anxiety disorder will often improve the depression or the depressive symptoms)

NICE have, more recently, also published guidelines concerning the management of depression. These are summarised in the linked item below.

Reference:

1. Anderson IM et al (2000). Evidence-based guidelines for treating depressive disorders with antidepressants: a revision of the 1993 British Association for Psychopharmacology guidelines. J Psychopharmacol, 14, 3-20.
2. NICE (April 2018). Depression in adults: recognition and management