Deciding about management and depression definitions

a. Factors that favour general advice and active monitoring

Subthreshold depressive symptoms:

  • Four or fewer of the recognised symptoms with little associated disability
  • Symptoms intermittent, or less than 2 weeks’ duration
  • Recent onset with identified stressor
  • No past or family history of depression
  • Social support available
  • Lack of suicidal thoughts.

b. Factors that favour more active treatment in primary care:

Mild depression: Few, if any, symptoms in excess of the 5 required to make the diagnosis, and symptoms result in only minor functional impairment.

  • Five or more symptoms with associated disability
  • Persistent or long-standing symptoms
  • Personal or family history of depression
  • Low social support
  • Occasional suicidal thoughts.

c. Factors that favour referral to mental health professionals

Moderate depression: Symptoms or functional impairment are between ‘mild’ and ‘severe’

  • Inadequate or incomplete response to two or more interventions
  • Recurrent episode within 1 year of last one
  • History suggestive of bipolar disorder
  • The person with depression or relatives request referral
  • More persistent suicidal thoughts
  • Self-neglect.

d. Factors that favour urgent referral to specialist mental health services

Severe depression: Most symptoms and the symptoms markedly interfere with functioning. This can occur with or without psychotic symptoms.

  • Actively suicidal ideas or plans
  • Psychotic symptoms
  • Severe agitation accompanying severe symptoms
  • Severe self-neglect.



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