Depression
Assessment, safety screening, and first-line treatment options.
Last reviewed January 5, 2026
Red flags
- Active suicidal ideation or plan, psychosis, or catatonia.
- Manic or hypomanic symptoms suggesting bipolar disorder.
Diagnosis
- Screen with PHQ-9 or similar tool and confirm DSM-5 criteria.
- Assess suicidality, psychosis, and bipolar symptoms before starting treatment.
Initial workup
- Review medical contributors (thyroid disease, anemia, medications, substance use).
- Document baseline sleep, appetite, energy, and functional impairment.
First-line management
- Offer psychotherapy (CBT, problem-solving therapy) and collaborative care.
- Start an SSRI/SNRI when symptoms are moderate to severe or persistent.
- Review adverse effects and safety within two weeks of starting an antidepressant; arrange earlier contact for higher risk.
Referral triggers
- High suicide risk, psychosis, or suspected bipolar disorder.
- Failure to respond to two adequate treatment trials or complex comorbidities.
References
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