NICE advocates a stepped care model for managing depression.

Step 1

This involves assessment, support, education on the disease itself and lifestyle measures that may help (e.g. good sleep hygiene, exercise, healthy diet, and minimising stress, alcohol, smoking and substance misuse), monitoring and referral if appropriate. Step 1 patients are defined as those with:

• Four or fewer symptoms with little associated impairment
• Symptoms that are intermittent or have been present for less than two weeks
• Symptoms of recent onset with an identified trigger
• No past or family history of depression
• Available social support
• No suicidal thoughts.

Step 2 

This is for patients who will benefit from more active primary care, who have:

• Five or more symptoms with some associated impairment (i.e. mild to moderate depression)
• Persistent or long-standing symptoms, including sub-threshold depression
• Personal or family history of the condition
• Poor social support
• Occasional suicidal thoughts.

Antidepressants should not be used routinely at this level because of a poor risk-benefit ratio.