Case definition

Persistent depressed mood OR markedly diminished interest in activities

PLUS TWO OF: disturbed sleep, change in appetite, beliefs of worthlessness or guilt, decreased energy, decreased concentration, indecisiveness, restlessness, slowed

AND difficulties with function

AND absence of physical condition (anemia, malnutrition, hypothyroidism, substance use, medication side effect), major loss/bereavement within 6 months, or previous episode of mania

Consider hospital referral for the following symptoms:

1. Current thoughts or plan for self-harm/suicide
2. History of thoughts or plan for self-harm in the past month or act of self-harm in the past year in a person who is now agitated, violent, distressed, or lacks communication

Clinical management

Provide psychoeducation
Reduce stress and strengthen social network supports
Promote physical activities, regular eating and sleeping, and functioning in daily activities and community life
Follow up in 1 week

Pharmacologic management

Fluoxetine 10mg po od

Adapted from:

mhGAP Intervention Guide for Mental, Neurological and Substance Use Disorders in Non-Specialized Health Settings. Mental Health Gap Action Programme. World Health Organization. 2010.