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Refer Complex Depression Early
- Primary care often initiates antidepressants but referrals to specialists can be delayed by long waitlists.
- If depression persists or is complex, seek specialty evaluation rather than relying solely on primary care management.
Dose Determines Antidepressant Target
- SSRIs/SNRIs often help anxiety symptoms at low doses and require higher doses to treat major depression.
- Dose matters: low doses target panic and anxiety while higher therapeutic doses target depressive syndromes.
Recognize Bipolar When Treating Depression
- Bipolar spectrum can present as depression but requires different treatment to avoid triggering mania.
- Antidepressants alone can worsen bipolar symptoms, so consider mood stabilizers if bipolarity is suspected.