When a person is depressed, the starting point is to obtain a professional assessment from the most qualified and experienced mental health professional available. Consultant Psychiatrists and Clinical Psychologists are the most appropriately qualified professionals in our community to provide such an assessment, although Consultant Psychiatrists, by virtue of their preliminary medical training prior to Psychiatry training, are also able to routinely assess for medical and physical causes of depression beyond the psychological and social domains.
Treatment recommendations follow assessment.
The skilled clinician will be aware that depression arises in a context, and attempt to identify and address this often hidden, or unrecognised, context.
Sometimes this previously unrecognised context will be a biological one, such as an undiagnosed medical condition (obstructive sleep apnoea, thyroid disease, cancer, anaemia, dementia, chronic pain disorders, etc). Sometimes the context will be psychological, such as a previously unrecognised underlying mental disorder (Bipolar Disorder, Lifelong Attention Deficit Disorder, Obsessive Compulsive Disorder, Post Traumatic Stress Disorder, etc,etc). Sometimes the context is a previously unrecognised, unaddressed social one, such as grief and loss, relationship issues, workplace stress, etc
As regards treatment, the key is for the assessing clinician undertaking the initial assessment to be a member of a mental health team capable of addressing not only the depression, but also the underlying context, working with members from a diversity of professional backgrounds (psychology, social work, psychotherapy, mental health nursing, general medical practice, psychiatry) with additional training in a range of therapies, including individual therapies, relationship and family therapies, pharmacotherapies, and hospital base therapies like intensive group therapies, TMS and ECT. In this team context treatment recommendations and implementation can be tailored to individual patient needs, rather than dictated by an individual clinician's particular training background.
A reminder that many Consultant Psychiatrists are trained in a range of psychotherapies, beyond simply pharmacotherapies, and that psychologists usually do not have extensive training in pharmacotherapies, in TMS or ECT or Psychoanalytic, Family or Group psychotherapies.
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