Depression: re-examining the management options

More than 1 in 10 Australians will experience an episode of depression in their lifetimes. 

 

For consumers, check out
 Depression: what you need to know

Depression: re-examining the management options

Key points

  • Promote and support non-pharmacological approaches, especially for mild and moderate depression.
  • Discuss treatment options openly with patients (and carers), provide information and address any misconceptions.
  • Take patient needs and preferences into account, as well as social and cultural factors, when making treatment choices
  • Advise patients what to expect from antidepressant medicines and agree on an adequate trial period if starting treatment.
  • Ask patients regularly about mood, function and adherence when monitoring treatment.

 

Medicinewise News: Exploring non-drug options in depression


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Non-pharmacological options, such as cognitive behaviour therapy (CBT) and e-Mental health tools, are appropriate first-line treatments for mild depression. They are as effective as antidepressants in moderate depression.

Find out about non-pharmacological options, including the evidence for their use and when to recommend them.

 

Australian Prescriber: Switching and stopping antidepressants


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Nicholas Keks, Judy Hope and Simone Keogh
Aust Prescr 2016;39:76-831 Jun 2016

Switching from one antidepressant to another is frequently indicated due to an inadequate treatment response or unacceptable adverse effects. All antidepressant switches must be carried out cautiously and under close observation.

Conservative switching strategies involve gradually tapering the first antidepressant followed by an adequate washout period before the new antidepressant is started. This can take a long time and include periods of no treatment with the risk of potentially life-threatening exacerbations of illness.

Clinical expertise is needed for more rapid or cross-taper switching as drug toxicity, including serotonin syndrome, may result from inappropriate co-administration of antidepressants. Some antidepressants must not be combined.

Antidepressants can cause withdrawal syndromes if discontinued abruptly after prolonged use. Relapse and exacerbation of depression can also occur. Gradual dose reduction over days to weeks reduces the risk and severity of complications.

Read the full article and download the Guidelines for switching poster

 

Evaluation: GP survey results for Managing depression program

We surveyed GPs who participated in the NPS MedicineWise Depression: re-examining the management options visiting program to find out what they learned and whether they thought it was worthwhile.

Key survey findings:

  • After the program there was in increase in GPs’ knowledge in relation to:
    • use of fluoxetine as a first-line choice to treat adolescents when an antidepressant is required (+15%)>
    • use of venlafaxine, based on adverse effects (+8%).
  • GPs who participated in the program showed improved confidence at selecting antidepressants that do not interact with any concurrent medicines that their patient is taking (+4%).
  • The proportion of GPs who would frequently refer their patients to online mental health programs increased (+5%).
  • Overall, after the program a greater proportion of GPs selected an SSRI rather than an SNRI for the first-line treatment of severe depression.

Find out what our respondents had to say.

 

CPD options

Clinical resources and tools

Guidelines

Therapeutic Guidelines

Psychotropic: Depression in adults. 2016.

Australian guidelines for the management of depression in adults. The main focus is on pharmacological treatment and also includes sections on psychological therapies and St John’s wort. 

British Association for Psychopharmacology guidelines

Evidence-based guidelines for treating depressive disorders with antidepressants. Published by the British Association for Psychopharmacology in 2015.

Cleare A, et al. Evidence-based guidelines for treating depressive disorders with antidepressants: A revision of the 2008 British Association for Psychopharmacology guidelines. J Psychopharmacol 2015;29:459-525. [PubMed].

Royal Australian College of General Practitioners

e-Mental health: A guide for GPs. 2015

e-Mental health interventions include instant messaging or video-based counselling services, consumer information portals, online support groups and more. 

This guide provides:

  • advice on using e-Mental health (although it is of a general nature, due to the absence of a significant body of evidence on how to use e-mental health resources in primary care)
  • signposts for where to find important resources and further information.

It can be used across the care continuum. This includes prevention and early intervention, primary treatment, adjunctive treatment and maintenance.

Tools

The Black Dog Institute provides these resources for encouraging people with depression to exercise:

 

For your patients

A fact sheet to help your patients find out more about management options for depression.

Depression: Your management options

Date published : 22 April 2019

Resource for health workers to use when discussing available treatments for depression and the place for antidepressants with Aboriginal and Torres Strait Islander people.

A fact sheet for Aboriginal and Torres Strait Islander people with information about what to expect when starting an antidepressant, the importance of taking it as prescribed and when to return to their clinic.

Support groups and links

Getting together with other people who know what it’s like to go through depression, or care for someone with depression, can be very helpful.  Support groups can be located through state-based mental health associations, The Black Dog Institute or GROW.

Suicide prevention and online support

General information about depression

Postnatal and antenatal depression

For men

For kids

For teens

For over-65s

For people from culturally and linguistically perse (CALD) communities

Online cognitive behavioural therapy (CBT)

Research summary

Psychotherapy

Reference Results / Recommendations

Cuijpers P, Andersson G, Donker T, et al. Psychological treatment of depression: results of a series of meta-analyses. Nord J Psychiatry 2011;65:354-64

A series of meta-analyses of 243 studies examining psychotherapies for adult depression.

Meta-analyses included comparisons between psychotherapy and: 

  • control group (147 studies)
  • another type of psychotherapy (63 studies)
  • pharmacotherapy (39 studies)

Findings included:

  • Different types of psychotherapy are efficacious, with small differences between them, including cognitive behavior therapy (CBT), interpersonal psychotherapy, problem-solving therapy, non-directive supportive therapy and behavioral activation therapy.
  • Efficacy of psychotherapy for mild to moderate depression is about the same as pharmacotherapy
  • Combined treatment is more effective than psychotherapy alone and pharmacotherapy alone.
  • Psychotherapy is not only effective in depressed adults in general, but also in older adults, women with postpartum depression, patients with general medical disorders, in inpatients and in primary care.

Antidepressant discontinuation

Reference Results / Recommendations

Shelton RC. Prim Care Companion J Clin Psychiatry 2001;3:168-74


Review of discontinuation of antidepressants and antidepressant discontinuation syndrome, including:

  • Risks
  • Reactions
  • Distinguishing relapse and recurrence from discontinuation responses
  • Management
  • Prevention