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In the patient who is depressed:

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Depression: When to refer to a specialist

  • Complicating comorbidity (substance abuse, personality disorder, anxiety disorder)
  • Severe presentation (serious suicidality, psychosis, bipolar disorder, especially bipolar I, with manic episodes)
  • Diagnostic clarification (bipolarity, personality disorder comorbidity)
  • Refractory to standard treatment (CBT, two or more medication trials)
Adapted from Raymond W. Lam, The patient who is depressed Psychiatry in primary care (CAMH, 2011)

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Clinical guidelines

Major depressive disorder in adults: Diagnosis and management (BC Guidelines, 2013)

Depression in adults: Recognition and management (Nice guideline CG 90, 2009)

Depression in adults with chronic physical health problems: Recognition and management (NICE guideline CG91, 2009)

Depression in children and young people: Identification and management (NICE guideline CG28, 2005)

Management of depression in children and young people with moderate to severe depression: A treatment flowchart based on the NICE guidelines (Cundill Centre, CAMH)