Last reviewed
2026-02-06
Workflow pack
Depression and anxiety initial care
Stepwise workflow for first-line treatment, medication start counseling, and safety escalation criteria.
Trust and governance
Use only within this workflow's defined scope and exclusions.
Clinical owner
Family Medicine Editorial Team
Risk tier
Medium
Review cadence
Every 6 months
Next due 2026-08-06
Review status
Current
Scope limits
Initial outpatient management and follow-up planning for common mood/anxiety disorders.
Exclusions (escalate/redirect)
- Imminent self-harm or harm-to-others risk.
- Severe psychiatric instability requiring urgent specialist care.
References
Escalate-now emphasis (medium-risk workflow)
Treat red-flag findings as urgent. Escalate the care pathway early if concern persists or follow-up reliability is uncertain.
At a glance
Rapid decision framing for in-visit use. Educational only; always apply clinical judgment.
Immediate actions
- Clarify symptom burden, functional impact, and immediate safety concerns.
- Use short validated screens to support baseline assessment and follow-up.
- Discuss treatment preferences and barriers early (therapy access, medications, cost).
Red flags / escalate now
- Active suicidality, psychosis, severe self-neglect, or rapid decompensation.
- Substance-related instability or inability to ensure safe outpatient follow-up.
- Significant deterioration after treatment start requiring urgent reassessment.
First-line plan
- Offer evidence-based non-pharmacologic and pharmacologic options using shared decisions.
- If starting SSRI, set expectations for onset, side effects, and early symptom monitoring.
- Use structured follow-up and symptom reassessment at each touchpoint.
Follow-up and monitoring
- Schedule early follow-up after treatment initiation (1-2 weeks where risk is higher).
- Track symptom trend using same tool over time for comparability.
- Escalate care pathway when response remains limited or risk increases.
Condition guidance
Prescribing aids
Referral checklists
Tools and calculators
Patient handouts
Return precautions (patient script)
Suggested plain-language wording for safety-net counseling:
If symptoms get worse, new warning signs appear, or you cannot follow the plan from this visit, seek urgent care now.
- Use with the specific red flags listed on this page.
- Confirm follow-up timing and where to go after-hours.
- Document that return precautions were reviewed and understood.
Visit-close checklist
- Document disposition, rationale, and unresolved diagnostic uncertainty.
- Give explicit return precautions and follow-up timeline before ending visit.
- Attach a relevant handout when available to reinforce adherence and safety-netting.