Synopsis
Match evidence-based psychological, social and medication options to depressive severity, function, preference and prior response, begin with the least intrusive effective choice and escalate through planned review rather than passive waiting.
- Treat immediate risk, housing, pain, substance use, physical illness and safeguarding needs alongside depression rather than waiting for mood remission.
- For less severe depression, discuss active monitoring, guided self-help, structured group physical activity, group behavioural activation or CBT and mindfulness-based options according to NICE and preference.
- Do not routinely make antidepressants the initial offer for less severe depression unless the person understands options and prefers medication.
Key red flags
A person with less severe symptom count may still need urgent care when suicide risk, psychosis, safeguarding or physical compromise is present.
Investigation priorities
Choose an initial option aligned with clinical need, previous response, goals and treatment burden.
Management branches
Symptoms and impairment fall within less severe depression without an overriding urgent need.
- Explain active monitoring and guideline-listed psychological, behavioural and social options and identify the person's priorities and access barriers.
- Offer the least intrusive acceptable intervention, while prescribing an antidepressant when informed preference supports it rather than as routine default.
Key medicines
SertralineFor adult major depression, start 50 mg orally once daily; if needed, increase in 50 mg steps no more often than weekly to a maximum 200 mg daily.
MirtazapineUse 15 to 30 mg orally at night initially, then adjust by response and tolerability within the licensed 15 to 45 mg daily range.