Treatment of Depression
Depression is a common and serious mood disorder causing persistent feelings of sadness, hopelessness, and loss of interest in activities. It affects how a person thinks, feels, and handles daily activities. Effective treatments include therapy and medication.
Managing Depression effectively requires a combination of medical treatment, lifestyle modification, and regular monitoring. With a structured management plan, most people with Depression can maintain a good quality of life and prevent serious complications.
First-Line Treatment Principles
- ✓Establish accurate diagnosis with standardised rating scales (PHQ-9, GAD-7, YMRS, PANSS)
- ✓SSRIs or SNRIs as first-line for depression, anxiety disorders, OCD, and PTSD
- ✓Lithium or valproate as mood stabilisers in bipolar disorder
- ✓Antipsychotics for schizophrenia; clozapine for treatment-resistant cases
- ✓Psychotherapy (CBT, IPT, DBT) as first-line or adjunct in most psychiatric conditions
What to Do Now
- Learn your personal risk factors for Depression (family history, age, lifestyle)
- Attend regular health check-ups and screening tests appropriate for your age and risk
- Track new or changing symptoms, especially those associated with Depression
- Use our AI symptom checker to assess whether your symptoms fit an early Depression pattern
- Discuss preventive strategies and early monitoring with your GP
- Build a personalised management plan with your GP or specialist
- Adhere consistently to prescribed medications — do not stop without medical advice
- Adopt a Depression-appropriate diet (anti-inflammatory, low-glycaemic, or disease-specific)
Medications Used in Depression
Fluoxetine is a selective serotonin reuptake inhibitor (SSRI) used as a first-line treatment for depression, anxiety disorders, OCD, and PTSD.
Sertraline is a selective serotonin reuptake inhibitor (SSRI) used as a first-line treatment for depression, anxiety disorders, OCD, and PTSD.
Paroxetine is a selective serotonin reuptake inhibitor (SSRI) used as a first-line treatment for depression, anxiety disorders, OCD, and PTSD.
Citalopram is a selective serotonin reuptake inhibitor (SSRI) used as a first-line treatment for depression, anxiety disorders, OCD, and PTSD.
Escitalopram is a selective serotonin reuptake inhibitor (SSRI) used as a first-line treatment for depression, anxiety disorders, OCD, and PTSD.
Fluvoxamine is a selective serotonin reuptake inhibitor (SSRI) used as a first-line treatment for depression, anxiety disorders, OCD, and PTSD.
Venlafaxine is a serotonin-norepinephrine reuptake inhibitor (SNRI) used to treat depression, anxiety, and certain pain conditions including fibromyalgia and neuropathy.
Duloxetine is a serotonin-norepinephrine reuptake inhibitor (SNRI) used to treat depression, anxiety, and certain pain conditions including fibromyalgia and neuropathy.
Non-Pharmacological Management
- •Psychotherapy: CBT for depression, anxiety, OCD, PTSD; DBT for borderline PD; ACT for chronic conditions
- •Regular aerobic exercise: 150 min/week — reduces depression scores comparably to antidepressants in mild-moderate MDD
- •Sleep hygiene: critical in depression, bipolar, and anxiety — circadian rhythm stabilisation
- •Alcohol and substance avoidance: major driver of psychiatric deterioration
- •Social support and peer support groups
- •Mindfulness-based cognitive therapy (MBCT) to prevent MDD relapse
- •Crisis planning: safety plan, emergency contacts, medication access
Treatment Goals
Monitoring Parameters
- ◆Validated symptom scales: PHQ-9 (depression), GAD-7 (anxiety), MADRS, YMRS — at each visit
- ◆Side effect monitoring: weight, metabolic parameters (antipsychotics), thyroid (lithium), LFTs (valproate)
- ◆Lithium levels: 5–7 days after initiation/dose change; then every 3–6 months when stable (target 0.6–1.0 mmol/L)
- ◆ECG: QTc monitoring with antipsychotics (ziprasidone, amisulpride, haloperidol)
- ◆Metabolic syndrome screening: waist circumference, BP, fasting glucose, lipids — annually on antipsychotics
- ◆AIMS for tardive dyskinesia (antipsychotics) — 6-monthly
Red Flags — When to Escalate
- ⚠Any of the characteristic symptoms of Depression — even mild — in a high-risk individual
- ⚠Progressive worsening of early warning signs over weeks
- ⚠Laboratory abnormalities (e.g., blood sugar, inflammatory markers) without full symptoms
- ⚠Unexplained weight loss, night sweats, or fatigue persisting >2 weeks
- ⚠Strong family history of Depression combined with new relevant symptoms
- ⚠Sudden worsening of Depression symptoms despite established treatment
Escalation Criteria
- →Active suicidal ideation with intent/plan → emergency psychiatric assessment; hospitalisation if risk confirmed
- →Psychotic relapse in schizophrenia → urgent psychiatric review; consider clozapine if ≥2 antipsychotic failures
- →Bipolar manic episode → inpatient; optimise mood stabiliser; antipsychotic augmentation
- →Treatment-resistant depression (≥2 failed SSRI trials) → augmentation (lithium, aripiprazole), referral, TMS/ECT consideration
Special Populations
Clinical Insights
Compare With Similar Conditions
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