Depression — Interventions Common to All Types of Major Depression — Clinical Pathway: Outpatient Behavioral Health and Primary Care

Depression Clinical Pathway — Outpatient Behavioral Health and Primary Care

Interventions Common to All Types of Major Depression

Patient Education/Psychoeducational Tools

School Accommodations

Support can be provided in the school setting to minimize the impact of symptoms on academic performance and to maximize day-to-day functioning.

Short-term school adjustments or accommodations may be beneficial. Examples include the following:

  • Extended time on projects, tests, and homework assignments
  • Breaking down of assignments into smaller chunks
  • Planning for how the patient can most effectively make up missed work following school absences due to psychiatric symptoms or mental health treatment
  • The designation of a specific point-person at school that the patient can go to for check-ins during recess, lunchtime, or non-essential classes.

It is important that any school plan be developed through the collaborative efforts of the patient, parents, teachers, and clinicians in order to identify the highest priority emotional and/or academic concerns as well as accommodations that are effective and reasonable for teachers to employ. All accommodations should progressively work toward goals agreed upon by the patient, parents, and the school and should be set in a way such that the patient can be recognized for success.

It is recommended that the school (e.g., guidance counselor, school psychologist, social worker, and teachers) be informed of the patient’s depression diagnosis, so that a collaborative relationship is initiated.

Alternative or Complementary Interventions

Natural or Over the Counter Supplements
  • There are emerging studies about whether natural over-the-counter supplements can be beneficial for adolescents with depression, although more research is needed.
  • There has been some mixed but favorable trials in adults with depression for supplementation with Omega 3 Fatty Acids (EPA ≥ 60% at a dosage of ≤ 1 g/d) and Vitamin D (2000 IU daily x 3 months especially when serum Vitamin D levels are less than 24).
  • The use of St. John’s Wort is not recommended as there is no clear evidence of efficacy in the treatment of child and adolescent depression.
Initiation of Behavioral Strategies Behavioral interventions including physical activity and bright light therapy have demonstrated clinically significant improvement in depressive symptoms on standardized rating scales in small studies.
  • Exercise – 60 minute sessions of aerobic physical activity three times per week for 12 weeks demonstrated clinically significant decreases in depressive symptoms on the CDRS-R in 13 depressed adolescents (9 of the 13 were additionally receiving psychotherapy or medication management).
  • Bright Light Treatment (2500 lux) 1 hour every morning for at least 1 week as monotherapy demonstrated clinically significant decreases in depressive symptoms on the BDI in 28 depressed adolescents in this cross-over placebo controlled study