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Table 1 Six prioritised recommendations for managing depression in the elderly in primary care

From: Tailoring interventions to implement recommendations for the treatment of elderly patients with depression: a qualitative study

Prioritised recommendations Full recommendation to be discussed in the groups and interviews
1. Social contact Primary care physicians and other health care professionals should discuss social contact with elderly patients with depression, and recommend actions (e.g. group activities) for those who have limited social contact
 When needed, regular social contact with trained volunteers, recruited from centres for voluntary organisations, the red cross, mental health or community day care centres
When possible, the patient’s relatives should be involved in the plan to improve social contact
2. Collaborative care plan All municipalitiesa should develop a plan for collaborative care for patients with moderate to severe depression. The plan should describe the responsibilities and communication between professionals who have contact with the patient, within primary care and between primary and specialist care. In addition, the plan should appoint depression case managers who have a responsibility for following the patient. The plan should describe routines for referral to specialist care
3. Depression case manager Primary care physicians should offer patients with moderate to severe depression regular contact with a depression case manager
4. Counselling Primary care physicians or qualified health care professionals should offer advice to elderly patients with depression regarding:
 Self-assisted programs, such as literature or web-based programs based on cognitive behavioural therapy principles
 Structured physical activity programmes, individually or group-based
 Healthy sleeping habits
 Anxiety coping strategies
 Problem solving therapy
5. Mild depression Primary care physicians should usually not prescribe antidepressants to patients with mild depression. Primary care physicians may consider prescribing antidepressant medication to patients who suffer from a mild episode of depression and have previously responded to antidepressant medication when moderately or severely depressed
6. Severe depression, recurrent and chronic depression and dysthymia Primary care physicians should offer these patients a combination of antidepressant medication and psychotherapy. If the physician is not trained to provide the patient with psychotherapy, patients should be referred to trained health care professionals
  1. aMunicipalities are the atomic unit of local government in Norway and are responsible for outpatient health care services, senior citizen services, and other social services. There are 429 municipalities