Diagnosis

• n/a

Investigation

• Assess severity: PHQ-9 questionnaire
• FBC, ESR, TFTs, B12/Folate, U&E’s, Gluc, Ca2+
• Toxicology
• Dexamethasone suppression test (Cushing’s)
• Cosynotropin (ACTH) stimulation test (Addison’s)

Management

Acute

• Suicide risk assessment

Conservative

• Mild to Moderate – wait and watch approach
• Sleep hygiene advice
• Computerised CBT / Individual CBT
• Structure group physical activity

Medical

• Mild - Moderate: SSRI only if >2 yr or past Ψ
• Severe: SSRI+ high intensity CBT / inter personal
• NB Sertraline > fluoxetine
• No point in switching SSRI try switching to NSRI (metazepione) or TCA if resistant. Be aware of increased risk of suicide initially and time to efficacy as well as serotonin syndrome
• Anxiety 20 to depression, Tx depression first

Intervention

• Electro shock therapy only if life limiting

NICE Source: CG90 Depression in adults: recognition and management. Summary compiled by Dr D P Sheppard MBBS.