Depression

Key points

• Core symptoms (≥ 2 weeks): low mood · anhedonia · low energy/fatigue.
• Associated: poor concentration, guilt/worthlessness, hopelessness, sleep/appetite change, psychomotor change, suicidal ideation.
• NICE stepped care: mild → watchful waiting/exercise/guided self-help; moderate-severe → psychological therapy (CBT) + antidepressant.
• SSRI first-line (sertraline/fluoxetine); allow 4–6 weeks; review at 2 weeks if < 30 years (suicide risk).
• ECT: severe/life-threatening depression (refusing food), psychotic depression, previous good response.

Decision points in this pathway

• Mild?
• Life-threatening/psychotic/previous ECT response?

The full step-by-step algorithm, including what to do at each branch, opens in the app for approved members.