Summary
The protocol addresses depressive episodes and recurrent depressive disorder. It describes persistent low mood, loss of interest or pleasure, reduced energy, fatigue, impaired concentration, sleep and appetite changes, guilt, pessimism, and thoughts or acts of self-harm. Assessment considers symptom duration and number, disruption of ordinary functioning, psychotic features, severity, and previous episodes. Recurrent depressive disorder is distinguished by repeated depressive episodes without a history meeting criteria for mania or hypomania.
Initial recognition may occur in primary or general medical care, while formal diagnosis is made by a psychiatrist. Evaluation includes targeted questioning about current and previous episodes, suicide risk, possible manic symptoms, psychoactive-substance use, medication exposure, and relevant medical illness. Severity and change over time may be measured with the Hamilton and Montgomery–Åsberg depression scales. Physical examination, laboratory tests, and instrumental investigations are used for differential diagnosis, assessment of medical risk, and safe treatment planning rather than as independent diagnostic tests for depression.
Care is planned according to severity, psychotic symptoms, suicide risk, comorbidity, adherence, and previous response. The protocol separates acute, stabilization, and relapse-prevention phases. Mild and some moderate episodes may be treated as outpatients; severe or psychotic depression and high suicide risk require inpatient care. Treatment includes antidepressants, psychoeducation, and validated psychotherapy, particularly cognitive behavioral and interpersonal approaches; specialized interventions may be considered for severe or resistant illness. Following improvement, continuation of effective treatment, monitoring of adverse effects, restoration of functioning, and recognition of early relapse signs are emphasized. This is a summary of the protocol, not an individual treatment recommendation.