Referral criteria from primary care - depression

Referral to a psychiatrist is indicated in the following circumstances (1):

• if the patient is suffering from psychotic symptoms
• if the patient has a history of bipolar effective disorder
• if there is a risk of suicide

Also it is appropriate for consultation with, or referral to, a psychiatrist (or a specialist in the treatment of affective disorders) when (1):

• the practictioner does not feel sufficiently experienced to manage a patient's condition
• if two or more attempts to treat the patients depressive disorder have failed or only resulted in a partial response

NICE suggest that (2) "..When a patient's depression has failed to respond to various strategies for augmentation and combination treatments, referral to a clinician with a specialist interest in treating depression should be considered.."

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 2007). Management of depression in primary and secondary care