Source Health Care Guideline: Major Depression in Adults for Mental Health Care Providers: Bloomington (MN). Institute for Clinical Systems Improvement (ICSI); 2001 May

    MAJOR DEPRESSION IN ADULTS FOR HEALTH CARE PROVIDERS

1. Patient presents with depressive symptoms at mental health department.

2. Evaluate psychiatric symptoms and co-morbidities

            A. Axis 1 = Clinical Disorders

            B. Axis 2 = Personality Disorders

            C. Axis 3 = General Medical Conditions

            D. Axis 4 = Psychosocial and Environmental Problems

E. Axis 5 = Global Assessment of Functioning

3. Does patient fit DSM-IV criteria for major depressive episode, if;

4. Out of Guideline

5. Does patient need emergency treatment;

6. Consider hospitalization - Out of guideline

7. Reenter

8. Is active chemical abuse/dependency present;

9. Evaluate and treat for chemical dependency

10. Treat for current or most recent episode using medication and/or psychotherapy

      (If a subtype exists, specific therapy may be indicated)

       Educate about Depression

Subtypes

                           Atypical major depressive disorder

                           Psychotic

                           Seasonal Affective Disorder

                           Melancholic

                           Catatonic

                           Postpartum

11. Is patient responding adequately?

12. Evaluate dose, during and compliance

13. Maintenance and continuing care of Major Depressive Episode

14. Consider other strategies

            Augment Therapy

            Switch Therapy

            Consider other biological therapies

            Add and/or modify psychotherapy

            Hospitalize

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