<prompt> Answer this question truthfullyWhat does the Clinical Depression Resident Survival Guide entail?  <response>: <reason> Shown below is an algorithm summarizing the treatment of Clinical depression:Abbreviations: ECT: Electroconvulsive Therapy, MAOI Monoamine oxidase Inhibitor, TCA Tricyclic Antidepressant, SSRI Selective Serotonin Reuptake InhibitorPresumptive diagnosis of Clinical Depression Determine the level of severity and functional impairment Is referral to mental health care indicated?: Unclear diagnosis Evidence of psychotic features, mania, hypomania Signs of co-morbid psychiatric conditions Unable to treat in primary care Need for psychosocial interventions Patient preference No Yes Discuss treatment options and patients preferences Refer to mental health specialty careInitiate treatment according to severity and follow-up in 1-2 weeks Severity PHQ-9 Score Functional impairment Initial treatment Mild 10-14 Mild Monotherapy - antidepressant or psychotherapy; or possibly combination of both Moderate 15-19 Moderate Antidepressant or psychotherapy; or possibly combination of both Severe 20 Severe May start with antidepressant or psychotherapy but prefer combination of both Follow up in 2 weeks: Symptoms improved Treatment is well-tolerated and no side-effects Patient is adhering to treatment Yes No Modify treatment: Increase dose Augmentation of the medication Switch to another agent Combine psychotherapy and pharmacotherapy Somatic intervention Inpatientresidential treatment Continue current treatment Re-assess in 4-6 weeks Some indications for inpatient care: Presence of suicidal ideation Refusal to eat or drink Severe malnutrition Presence of psychiatric conditions or other general medical comorbidity that make outpatient treatment unsafe or ineffective Catatonia Yes Evaluate: Full remission ? Continue current treatment to prevent relapse Possible long-term maintenanceThe algorithm below shows the management plan in brief in case of mild, moderate, and severe depression:Mild to moderate Depression Remission Psychotherapy Pharmacotherapy Remission No response No response Change to anti-depressant Partial Response Change to anti-depressant OR Switch to psychotherapy Optimize the treatment: Increase frequency of psychotherapy Give maximum tolerable doses of the anti depressant Change or give combination therapy: If patient is getting psychotherapy: Add antidepressant If patient is recieving antidepressant: Add psychotherapy or change the anti depressant AugmentationCombination: If patient is recieving antidepressant: Add a second antidepressant OR augment the medication depending on tolerability and side effectsThe algorithm below shows the management plan in brief in case of severe depression:Severe Depression Assess the patient: Ask about patients preference of treatment Past history of good response to treatment of ECT Recieving other treatment or high risk of drug interaction High risk of suicide Refuse to eat or drink Has catatonic features Has other features of psychosis Non responding to any other treatment Assess the patient: Ask about patients preference of treatment Past history or family history of good response to treatment of ECT Low risk of drug interaction High risk of suicide ECT Pharmacotherapy Pharmacotherapy No response Partial response Optimize the treatment: Give the maximum tolerable doses of the antidepressant No further response: Switch to a different antidepressant from same or different pharmalogical class Add ECT Add a second anti depressant Augment the medicationMedications used to treat Depression: Medications used to treat Depression Mechanism Name Dose Side effects Selective Serotonin Reuptake Inhibitor Fluoxetine Paroxetine Fluvoxamine Sertraline Citalopram Escitalopram 20-80 20-60 50-300 50-200 20-40 10-20 Sexual dysfunction GI disturbances Weight loss gain Insomnia Anxiety Tricyclic antidepressant Amitriptyline Doxepin Imipramine Clomipramine 50-200 75-300 75-300 75-300 Sexual dysfunction Anticholinergic effect Drowsiness Weight gain Conduction abnormality Norepinephrine Serotonin Reuptake Inhibitor Venlafaxine Duloxetine Milnacipran Desvenlafaxine 75-300 20-60 50-200 Mild anticholinergic effect Drowsiness GI distress Non adrenaline and Specific Serotonin Inhibitor Mirtazapine 15-45 Mild anticholinergic effect Drowsiness GI distress Atypical antidepressant Trazodone Nefazodone 150-300 100-300 Anticholinergic effect drowsiness Weight gain Conduction abnormality Mono amine oxidase Inhibitors Phenelzine Isocarboxazid Tranylcypromine 45-90 30-60 20-60 Orthostatic hypotension Headache Insomnia Drowsiness Selective Serotonin Reuptake Inhibitor Vilazodone 20-40 Diarrhea Nausea Vomiting Insomnia 