Moderate Depression
Has 5-6 symptoms in total including at least one key symptom



Severe Depression
Has 7+ symptoms including at least 1 key symptom


Recurrent Depression



Atypical Depression box

















  Step 3: Possible Treatment Options

Consider patient choice and information


Consider asking advice or referral to specialist mental health services if:

  • Significant degree of functional impairment

  • Significant psychiatric co-morbidities e.g. substance misuse, personality disorders.

  • Significant neurological disorders e.g. learning disability, epilepsy or Parkinson’s disease.

  • Patient's medical history suggests referral to secondary care as most appropriate.

  • Physical co-morbidities or their treatment impacts depression management.

  • Not responded or intolerant to two different classes of antidepressants.

  • Pregnancy, lactation and immediate post partum.

  • Elderly associated with cognitive impairment



There is a need for clear and ongoing communication between all parties involved in the care and support of the patient


Immediate Referral:

  • Treatment-resistant

  • Psychotic depression

  • Those at significant risk

    Refer to specialist Mental Health Services utilising local Choose and Book and Care Coordination arrangements Include essential referral information