MODERATE DEPRESSION
Week 0
INITIAL/SCREENING APPOINTMENT
Mr Allen attends surgery complaining of “not feeling right” since being made redundant 6 months ago. Unable to establish any specific physical complaints the GP asks Mr Allen what he is doing with his time and discovers that the patient is spending most of his time in the house “just watching TV”. He has stopped going to his darts matches as “it all seems like too much effort”. Completion and scoring of the ICD-10 and PHQ-9 indicates a moderate level of depression. The patient also discloses that he had a similar depression when his wife left him 4 years ago. He has never posed a risk to himself or others but on this occasion has thought his family “would be better off without him”. The GP probes into this further and using the recommended risk questions asks if the patient has made any plans to act on his thoughts. Having established that Mr Allen has no plans to harm himself because he would leave too much debt for his daughter the GP discusses the treatment options with the patient. The GP and the patient agree to try medication. The GP prescribes an anti-depressant which has minimal risk in overdose and explains side-effects and the time for medication to work. The GP explains to the patient that he will be assigned a practice nurse to manage his case and support and assist him over the next few months, who will contact him by telephone in the next week to discuss the medication. The patient is given a patient information leaflet on depression and an appointment to be seen in the clinic at the practice held by the local Citizens Advice Bureau (CAB) regarding his debt problems.
Week 1
INITIAL FOLLOW UP (PN)
One week later the practice nurse contacts Mr Allen to discuss his medication, answer any queries he has, and to give support. The nurse establishes that he forgot about his CAB appointment and reschedules him another one and agrees to remind him by telephone the afternoon before the appointment.
Weeks 3, 5, 7, 9
FOLLOW UP (PN)
The practice nurse continues to contact Mr Allen to discuss his medication, answer any queries he has, and to give support. Mr Allen did attend his appointment and is being supported by the CAB worker to deal with his debts.
Week 12
PROGRESS REVIEW SESSION (PN)
The PN sees Mr Allen to conduct a review of his progress with the PHQ-9. Scoring the questionnaire indicates that Mr Allen has had a partial response to the medication. Further discussion indicates some problems with loneliness. Mr Allen is assisted to increase his social support through activity scheduling/behavioural activation and using local support groups. Mr Allen is happy with this and does not wish to change his medication at present. This information is discussed with the GP and added to the medical records.
Months 2, 4, 8, 10
POST ACUTE PHASE (PN)
The PN conducts telephone follow-up and checks progress is maintained and discusses medication.
Months 6 & 12 (PN)
The patient is invited for an appointment with the PN to review progress and the PHQ9 is completed. Mr Allen has continued to improve and his symptoms have remitted.