Depression
32
STEP 6: Does the patient require psychiatric care?
• Suicidal ideation or plan
• Dangerous to self or others
• Psychotic depression
• Bipolar disorder
• Depression with comorbid alcohol dependency or inappropriate substance use
• Depression unresponsive to one or two trials of antidepressant at appropriate doses
Treatment
Depression
(unipolar, non
psychotic,
dysthymia,
complicated grief )
• Psychotherapy alone
• Medication alone (SSRI, serotonin norepinephrine reuptake
inhibitor [SNRI], bupropion or mirtazepine based on
comorbid conditions/side effect profile)
• Psychotherapy plus medication
• If severe, consider electroconvulsive therapy (ECT)
• Inpatient psychiatric treatment may be indicated if there
is a suicidal plan, severe weight loss from depression, or
negativism
20
Depression
(unipolar,
psychotic)
SSRI or SNRI plus atypical antipsychotic (documentation
supporting use of antipsychotic is required)
Melancholic
Depression
Typically does not respond to psychotherapy alone and requires
pharmacotherapy or ECT
Bipolar Depression Psychiatrist input is strongly encouraged as use of an anti-
depressant can precipitate mania. Treatment might include a
mood stabilizer, antipsychotic, or ECT
20
STEP 7: Determine most appropriate treatment
