5 Steps to Review Persistent Depression in General Practice

“Doing the same thing again and expecting different results is insanity.”

Persistent depression is one of the most common and frustrating presentations in general practice.

Patients return saying:

“The meds aren’t working”
“Therapy didn’t help”
“I still feel the same”

The problem is often not resistance.

It’s missed structure.

👉 If you want the full system approach, read:
5 Steps to Manage Complex Mental Health Patients

Step 1 — Review Diagnosis

Before escalating treatment, ask:

Is this truly unipolar depression?

Start with a proper framework:
👉 Mental Health History Guide

Screen for:

organic causes (stroke, hypothyroidism, Cushing’s, etc.)
bipolar disorder
schizophrenia
PTSD / complex PTSD → see PTSD Guide
ADHD / autism → ADHD Guide for Australian GP
intellectual disability / learning difficulties
substance use
gender dysphoria

👉 Wrong diagnosis = wrong treatment

Step 2 — Review Medications

Check the fundamentals:

Right medication?
Adequate dose?
Adequate duration (≥6–8 weeks)?
Adherence?
Side effects (e.g. serotonin toxicity, agitation)?

For broader prescribing structure:
👉 Depression Overview for GPs

👉 No response → adjust, switch, or augment

Step 3 — Review Psychotherapy

Ask:

Is the patient actually engaging?
Is there a good therapeutic connection?
Is it the right type?

Examples:

CBT
EMDR
Interpersonal Therapy
DBT

If you're structuring this formally:
👉 Mental Health Consult Framework

👉 If therapy isn’t helping → change approach or therapist

Step 4 — Address Psychosocial Factors

Depression does not exist in isolation.

This is where most treatment fails.

Explore:

social isolation
relationship breakdown
financial stress
work issues
unemployment
legal issues
housing instability

This links directly to whole-person care planning:
👉 More Than Just Depression

👉 Treatment fails if context isn’t addressed

Step 5 — Escalation Strategies

When needed:

psychiatrist referral
neurocognitive assessment
social support (housing, financial assistance)
NDIS / community services
financial counsellor

This fits within structured planning:
👉 Mental Health Care Plan Guide (MHCP)

👉 You can’t manage complex care alone

The Real Problem

Most persistent depression isn’t due to:

“stronger illness”
or “treatment resistance”

It’s due to:

missed diagnosis
incomplete treatment
wrong therapy
ignored psychosocial drivers

If you don’t change the system, outcomes won’t change.

Why This Matters for GPs

You are rarely treating just depression.

You are treating:

depression + trauma
depression + chronic pain
depression + unemployment
depression + substance use

👉 This is why you need structured care systems:
If the Goal is Not Achieved — Fix the System

Where Caredevo Fits

Caredevo helps you structure this automatically:

problems
goals
tasks
psychosocial drivers
follow-up

Instead of:

👉 “review in 2 weeks”

You get:

✔ clear problems
✔ SMART goals → How to Write SMART Goals
✔ structured follow-up

Final Thought

Persistent depression is not something you “treat harder.”

It’s something you review better.

Explore More

Try It Yourself

See your next complex patient differently:

👉 https://caredevo.com/register