Referring to other services
Referring to psychotherapy
Patients with depression can benefit from additional support and guidance through psychotherapy. Psychotherapists can be accessible in the clinic or even outside the statutory health service, if patients wish and have the means to finance it.
Evidence for efficacy is most consistent for cognitive-behavioural therapy (CBT). CBT usually takes place over six weeks to six months. Patients are helped to identify and challenge cognitions that maintain depressed mood and to improve the daily balance between stress and duties versus relaxation and enjoyable activities.
Other approaches with some evidence for efficacy are interpersonal therapy (IPT) and mindfulness- or acceptance-based therapies. The latter seek to teach patients to avoid self-evaluation and self-judgment based on the content of their thoughts. Person-centred counselling is non-directive and is characterised by an empathic and supportive approach. Some types of psychotherapy are not evidence-based and, given the financial cost associated, patients should only access the best cost-effective interventions.
GPs are encouraged to inform themselves of what kind of therapy is available in their area. In order to minimise structural barriers, it can be helpful to provide patients with practical information about cost, location, and likely duration and focus of therapy.
Referring to psychoeducation
Most people will benefit from psychoeducation sessions that can be arranged in groups. Nurses and psychologists can be trained to conduct such sessions. If groups are successful they can evolve towards self-help groups. There are also psychoeducational resources and online tools for depression available, such as the iFightDepression self-management tool.
Referring to psychiatric treatment
A patient should be referred from primary to specialised psychiatric care if they are experiencing delusional (psychotic) depression, severe depression with suicidality, negativism, agitation, complicating comorbidity, bipolar depression, or treatment resistance.