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Depressed patient What I will do now What I will do now

Dr Spinks considers the responses to his questions

Over recent years, GPs have been accused of underdiagnosing and overdiagnosing depression and prescribing too few or too many antidepressants. So it is very useful to have clear suggestions on how to spot patients with serious depression and tips on the right treatment for the right patient. In particular the red flags for suicide risk will now be part of my routine work-up.
I was interested in the suggestion that counselling should be targeted at those with clear precipitating factors. I have tended to see it as the main alternative to medication but now I will be looking at using more CBT and exercise advice – although local access to CBT may limit this option to book and online versions.
SSRIs will remain my first-line antidepressants but I now have a clearer understanding of the place of second-line medications. I will be better placed to deal with treatment failures and less concerned at using both SSRIs and low-dose tricyclics in patients with both depression and chronic pain.

Dr Julian Spinks is a GP in Rochester, Kent

thps depression

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