Antidepressant response rates are higher for depression of a moderate to severe nature. For mild or subsyndromal depressive symptoms a complete assessment, ongoing support and monitoring, psychosocial interventions and lifestyle modifications should be the first lines of treatment. This may avoid the side-effects of medication and establish etiological factors important to future assessment and management. Antidepressants are appropriate in cases of persistent mild depression, where there is a past history of more severe depression, or where other interventions have failed.
Sources:
Barbui C, et al. Efficacy of antidepressants and benzodiazepines in minor depression: systematic review and meta-analysis. Br J Psychiatry. 2011 Jan;198(1):11-6. PMID: 21200071.
Cuijpers P, et al. Are psychosocial and pharmacologic interventions equally effective in the treatment of adult depressive disorders? A meta-analysis of comparative studies. J Clin Pyschiatry. 2008 Nov;69(11):1675-85. PMID: 18945396.
Esposito E, et al. Frequency and adequacy of depression treatment in a Canadian population sample. Can J Psychiatry. 2007 Dec;52(12):780-789. PMID: 18186178.
Fournier JC, et al. Antidepressant drug effects and depression severity: a patient-level meta-analysis. JAMA. 2010 Jan 6;303(1):47-53. PMID: 20051569.
Kirsch I, et al. Initial Severity and antidepressant benefits: a meta-analysis of data submitted to the Food and Drug Administration. PLoS Med. 2008 Feb;5(2):e45. PMID: 18303940.
National Institute for Health and Care Excellence. Depression in adults: evidence update [Internet]. 2016 Apr [cited 2017 May 5].