Once the diagnosis of major depression (w/severity) has been made bases on DSM criteria (DSM-IV-TR is the latest version addressing depression severity), the following treatments are indicated.
Pharmacotherapy: The use of medication in combination with psychotherapy is usually indicated (mild or moderate). It is important to determine if anxiety, bipolar activity, and/or psychosis is involved and treat with a combination of medications if indicated. The patient should be monitored every 1-3 weeks during the acute phase for effectiveness/side effects. Maintain medication for 6 months after symptoms are gone. If recurrence, consider keeping patient on medication for long-term maintenance (consult a psychiatrist). Both tricyclic antidepressants and SSRIs have been found effective in primary care settings, but SSRIs have fewer side effects (Arroll, et al., 2009).
Psychotherapy: In order for psychotherapy to be effective, the patient must be motivated to do the required work. The frequency of sessions varies, but is usually no less than once a week in the acute phase. Therapeutic options include cognitive psychotherapy, psychodynamic psychotherapy, and interpersonal therapy. After the acute phase, follow-up control visits should be maintained.
ECT: This is indicated in severe or psychotic cases, especially if suicide risk is high. It is often performed in conjunction with inpatient treatment. ECT has been found to be at least as effective as pharmacotherapy.