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Feature Article Psychiatry and psychology
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Adult depression: a step-by-step guide to treatment

Josephine Anderson, Verònica Gálvez, Colleen K Loo, Philip B Mitchell
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Abstract

A stepwise approach to the early detection and management of depression, guided by severity of presentation and treatment response, can ensure timely access to treatment. Evidence-based treatments range from e-mental health apps, psychological therapy and medication to neurostimulation. Correction
A correction for this article was published in the December 2015 issue of Medicine Today. The full text PDF for this article (see link above) has been corrected.

 

Key Points
  • A stepwise approach to evidence-based primary mental health care promotes early detection of patients with depression.
  • Early detection by GPs encourages more timely access to evidence-based treatments, including easily accessed and destigmatising e-mental health interventions.
  • Given the overall similarities in efficacy of antidepressants, the most important considerations when initiating pharmacotherapy are tolerability and safety, although some patients uniquely respond to some medicines and not others.
  • For patients with difficult-to-treat depression, an algorithmic management approach with steps that include increasing the antidepressant dose, switching antidepressants, augmenting with a nonantidepressant treatment and combining antidepressants improves the chance of patient recovery.
  • Neurostimulatory treatments such as electroconvulsive therapy and repetitive transcranial magnetic stimulation have an expanding role in the evidence-based treatment of severe depression.

    Picture credit: © Maxim Malevich/Dollar Photo Club. Model used for illustrative purposes only..