Table 1 Six prioritised recommendations for the management of depression in elderly patients

1. Social contact

Primary care physicians and other healthcare 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 municipalities^a 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 care managers who have a responsibility for following the patient. The plan should describe routines for referral to specialist care.

3. Depression care manager

Primary care physicians should offer patients with moderate to severe depression regular contact with a depression care manager.

4. Counselling

Primary care physicians or qualified healthcare professionals should offer advice to elderly patients with depression regarding:

• Self-assisted programmes, such as literature or web-based programmes 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 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 healthcare professionals.