What is the recommended treatment for mild depression?

Treatment for Mild Depression

For mild depression, psychological interventions should be considered as first-line treatment rather than antidepressants. 1

First-Line Treatment Options for Mild Depression

• Psychological treatments should be the initial approach for mild depression, with several evidence-based options available:

  • Cognitive Behavioral Therapy (CBT) 1, 2
  • Interpersonal therapy 1, 2
  • Problem-solving treatment 1
  • Behavioral activation 1

• Antidepressants should NOT be used as initial treatment for adults with mild depressive episodes 1

• Physical activity and relaxation training may be considered as treatment components for mild depression 1

Rationale for Avoiding Antidepressants in Mild Depression

• Evidence suggests that drug-placebo differences for antidepressants increase with depression severity, with virtually no difference in mild depression compared to placebo 1

• More than 60% of patients experience at least one adverse effect with second-generation antidepressants 2

• Common side effects include sexual dysfunction, gastrointestinal symptoms, and sleep disturbances 2

For Patients with Depressive Symptoms (Not Meeting Full Criteria)

• A problem-solving approach should be considered for people with depressive symptoms who are in distress or have some degree of impaired functioning but do not meet full criteria for a depressive episode 1

• Neither antidepressants nor benzodiazepines should be used for individuals with complaints of depressive symptoms in the absence of current/prior depressive episode/disorder 1

Treatment Duration and Monitoring

• If psychological interventions are insufficient and antidepressants are later considered necessary, treatment should not be stopped before 9-12 months after recovery 1

• Regular monitoring using validated assessment tools is recommended throughout treatment 2

Special Considerations

• For children aged 6-12 years with mild depression, antidepressants should not be used in non-specialist settings 1

• For adolescents with depression, fluoxetine (but not TCAs or other SSRIs) may be considered, with close monitoring for suicidal ideation 1

• School-based life skills education should be encouraged when feasible for children and adolescents 1

Clinical Pitfalls to Avoid

• Avoid prescribing antidepressants as initial treatment for mild depression despite their widespread use in clinical practice 1

• Avoid stopping psychological or pharmacological treatment too early, as this increases relapse risk 1

• Do not use psychological debriefing for recent traumatic events to reduce the risk of depressive symptoms 1