Treatment Options for Mild Depression
For mild depression, clinicians should consider a period of active support and monitoring before starting evidence-based treatments such as medication or formal psychotherapy. 1
First-Step Approaches for Mild Depression
Active Support and Monitoring
- Active support and monitoring is recommended as the initial approach for mild depression 1
- This includes:
- Psychoeducation about depression
- Supportive counseling
- Facilitating patient self-management strategies
- Regular monitoring of depressive symptoms and suicidality
Exercise Therapy
- Moderate intensity exercise can effectively reduce depressive symptoms 2
- Recommended exercise protocol:
- Aerobic exercise or mind-body exercise (e.g., yoga)
- 3-5 sessions per week
- Moderate intensity
- Duration of 4-16 weeks
- Group exercise with supervision improves adherence
Lifestyle Modifications
- Several lifestyle factors can be modified to improve mild depressive symptoms:
- Physical activity/exercise
- Dietary modifications
- Adequate sleep and relaxation techniques
- Enhanced social interaction
- Mindfulness-based meditation techniques
- Reduction of recreational substances (nicotine, alcohol, drugs) 3
When to Consider Additional Treatment
If symptoms persist after a period of active support and monitoring, the following evidence-based treatments should be offered:
Psychotherapy Options
- Cognitive Behavioral Therapy (CBT)
- Psychodynamic supportive psychotherapy
- Acceptance and commitment therapy
- Interpersonal therapy 1, 4
Pharmacotherapy Options
- Selective Serotonin Reuptake Inhibitors (SSRIs) are commonly used first-line:
- Sertraline: 25-50 mg daily initially, max 200 mg daily
- Escitalopram: 10 mg daily, max 20 mg daily
- Citalopram: 10 mg daily, max 20 mg daily (for elderly) 4
- Bupropion has lower rates of sexual side effects and may promote weight loss 4
Important Clinical Considerations
Monitoring and Follow-up
- First follow-up should be within 1-2 weeks of starting any treatment
- Regularly assess therapeutic response and adverse effects
- Full therapeutic effect of medications may take 6-8 weeks 4
Special Populations
- For adolescents with mild depression, the Guidelines for Adolescent Depression in Primary Care strongly recommend active support and monitoring before starting evidence-based treatment 1
- For elderly patients, medications with favorable side effect profiles and lower risk of drug interactions are preferred (e.g., sertraline, escitalopram) 4
Common Pitfalls to Avoid
- Rushing to medication: For mild depression, active monitoring should be tried first before moving to medication 1, 5
- Inadequate follow-up: Regular monitoring is essential, especially within the first 1-2 weeks of treatment initiation 4
- Overlooking comorbidities: 50-60% of individuals with depression have comorbid anxiety disorders that may require specific treatment approaches 4
- Discontinuing treatment too early: For first episode of depression, treatment should continue for 4-9 months after satisfactory response 4
Integrated Care Models
The American College of Physicians strongly recommends that primary care clinicians work with administration to organize clinical settings that reflect best practices in integrated and/or collaborative care models 1. These models have been shown to be more effective in improving outcomes by:
- Systematically identifying and tracking target populations
- Decreasing fragmentation across the care team
- Enhancing the patient's ability to self-manage their condition
When mild depression persists despite initial interventions or worsens to moderate/severe depression, consultation with mental health specialists should be considered 1.