Last reviewed 01/2018

In determining management is helpful to consider various points.

Severity of depression: mild, moderate or severe, determined mainly on the basis of the degree of low mood, but other factors should be taken into account. For example the presence of psychomotor retardation would exclude the description of "mild" depression. The presence of delusions indicates that the depressive illness is severe. Is there a suicide risk?

The presence of vegetative or biological symptoms: antidepressant drugs are likely to be effective if these symptoms are present.

The presence of delusions and/or hallucinations: purely psychological treatments and antidepressant drugs alone may not be sufficient. Antipsychotic drugs can be given in addition to antidepressants. However, the presence of these symptoms predicts good response to ECT.

The course of the illness: in particular whether there have been periods of abnormally high mood or frank manic episodes. If these have been present at any time, the patient is said to have a bipolar affective disorder. The implication of this for treatment is two-fold: firstly, in treating the current depression there is a danger of precipitating mania; and secondly prophylactic treatment with lithium may be indicated once the patient is no longer depressed.