Management of depression

The evidence for management of depression in people with developmental disability is not as robust as in the general population. Recommendations as for the general population are appropriate; see the Psychotropic guidelines.

Points that are specific for people with developmental disability are discussed below. See also Principles of management of psychiatric disorders in people with developmental disability and Additional management considerations in children and adolescents.

Common management mistakes include:

• use of medication when nonpharmacological interventions (eg psychological therapies, social and lifestyle interventions) are appropriate
• reluctance to prescribe medication or electroconvulsive therapy when indicated
• reluctance to trial an alternative medication if initial antidepressant is ineffective.

Psychological therapies are the preferred first-line management for mild depression, but are frequently overlooked in people with developmental disability. Psychological therapies should be considered, particularly in people with mild to moderate developmental disability who have relatively intact communication skills. In the primary care setting, psychoeducation, supportive psychotherapy, cognitive behavioural therapy (CBT), and social and lifestyle interventions are often appropriate therapies to use.

Detailed advice on drug therapy for depression is available in the Psychotropic guidelines. See also Precautions in prescribing psychotropic drugs for people with developmental disability.

For advice on the setting for acute treatment of people with developmental disability and severe depression, see Setting for acute treatment of a psychiatric disorder in a person with developmental disability.