Depression Clinical Pathway — Outpatient Behavioral Health and Primary Care

All of the following:
- 5-7 DSM-5 Symptoms of Major Depressive Disorder
- Minor Functional Impairment in at least one area or mildly distressing symptoms
- No Comorbid Psychiatric diagnoses
- No Suicidal ideation or behavior
- No Psychotic symptoms

Or Criteria Met for Other Specified Depressive Disorder (Same treatment applies as with Mild Major Depression)

Case Example

Moderate Major Depressive Disorder

All of the following:
- 5-7 DSM-5 Symptoms of Major Depressive Disorder
- Moderate Functional Impairment in at least one area or moderately distressing symptoms
- No Psychotic Symptoms

Can Include:
- Comorbid Psychiatric Diagnoses
- Suicidal Ideation or Behavior

Case Example

Severe Major Depressive Disorder

All of the following:
- At least 7 DSM-5 symptoms of Major Depressive Disorder
- Markedly impaired functioning in at least one area or seriously distressing symptoms

Presence of at least one of the following
- Comorbid Psychiatric Diagnoses
- Suicidal Ideation or Behavior
- Depression congruent psychotic symptoms

Case Example

Initial Treatment Considerations

Active Monitoring or
Supportive Psychotherapy or
Family Therapy or
Evidenced-Based Psychotherapy
- Cognitive Behavioral Therapy
- Interpersonal Psychotherapy for Adolescents

Initial Treatment Considerations

Evidence-Based Psychotherapy
- Cognitive Behavioral Therapy
- Interpersonal Psychotherapy for Adolescents
Medication Management
Adjunctive Family Therapy
Consider Consultation with Mental Health Specialist (non-mental health specialists)

Initial Treatment Considerations

Evidence-Based Psychotherapy
- Cognitive Behavioral Therapy
- Interpersonal Psychotherapy for Adolescents
Medication Management
Adjunctive Family Therapy
Consult with or Refer to Mental Health Specialist (non-mental health specialists)
Intensive Outpatient Program
Partial Hospitalization Program

Interventions Common to all Types of Major Depression

Psychoeducational Tools

School Accommodations

Alternative or Complementary Interventions

Continue Course of Treatment and Monitor Response

Treatment of Non-Responders or Resistant Depression

Discharge

Posted: June 2020
Revised: November 2023
Authors: J. Lewis, PhD; W. Wallace, DO; O. Lawrence, MD; R. Boyd, PhD; M. Greenspan, LCSW; S. Soffer, PhD; C. Law, PharmD

Evidence

Community Resource

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The clinical pathways are based upon publicly available medical evidence and/or a consensus of medical practitioners at The Children’s Hospital of Philadelphia (“CHOP”) and are current at the time of publication. These clinical pathways are intended to be a guide for practitioners and may need to be adapted for each specific patient based on the practitioner’s professional judgment, consideration of any unique circumstances, the needs of each patient and their family, and/or the availability of various resources at the health care institution where the patient is located.

Accordingly, these clinical pathways are not intended to constitute medical advice or treatment, or to create a doctor-patient relationship between/among The Children’s Hospital of Philadelphia (“CHOP”), its physicians and the individual patients in question. CHOP does not represent or warrant that the clinical pathways are in every respect accurate or complete, or that one or more of them apply to a particular patient or medical condition. CHOP is not responsible for any errors or omissions in the clinical pathways, or for any outcomes a patient might experience where a clinician consulted one or more such pathways in connection with providing care for that patient.