Depression is more than feeling sad or having a difficult day. It is a clinical disorder that can affect mood, interest and pleasure, energy, sleep, appetite, concentration, self-esteem and functioning. Some individuals may primarily present with fatigue, aches and pains or other physical complaints rather than spontaneously reporting sadness. A thoughtful and systematic approach is therefore essential.
Start with a Comprehensive Assessment
The first step is to establish the diagnosis through a detailed history, mental status examination and physical examination. Information from family members can be particularly valuable. The clinician should assess symptom severity, duration and functional impairment, while also looking for psychotic or catatonic symptoms, anxiety, substance use, suicide risk and relevant medical conditions. Depressive symptoms generally need to persist for at least two weeks and cause psychosocial dysfunction to meet diagnostic criteria.
Treatment Should Be Individualised
There is no single treatment that fits every patient. Treatment selection depends on severity, clinical features, comorbidities, previous treatment response, psychosocial circumstances, and patient preference. Available approaches include pharmacotherapy, psychotherapy, their combination and, when indicated, electroconvulsive therapy (ECT) such as in drug resistant cases. For mild-to-moderate depression, psychotherapy can be an important initial approach, particularly when psychosocial stressors or interpersonal difficulties are prominent. Cognitive behavioural therapy (CBT) and interpersonal therapy (IPT) are among the established psychotherapeutic approaches.
Pharmacotherapy includes antidepressants like SSRIs, TCAs, SNRIs, and MAOIs. Psychoeducation remains an important component: patients and caregivers should understand the illness, expected treatment response, possible adverse effects, adherence, and warning signs of relapse.
Think Beyond Symptom Relief
Management does not end when symptoms improve. Treatment progresses through acute, continuation and, when indicated, maintenance phases. The continuation phase aims to maintain recovery and prevent relapse, while maintenance treatment is considered particularly in recurrent depression. Patients and families should also learn to recognise early warning signs and seek help promptly if symptoms return.
Ultimately, the approach to depression is not simply “identify and prescribe.” It is to assess, ensure safety, understand the person, choose an appropriate treatment, monitor progress, and prevent relapse. A strong therapeutic alliance, psychoeducation and shared treatment planning can transform management from merely treating symptoms to supporting meaningful recovery.
Dr. Partik Kaur
Assistant Professor
Department of Psychiatry
CMC, Ludhiana
