Scope
People presenting with depressive symptoms in Australian primary, rural or remote care. The acute assessment source is the Queensland Primary Clinical Care Manual and is not a national maintenance-treatment guideline. The Australian Prescriber source addresses stopping antidepressants, not which antidepressant to start. This page therefore covers recognition, immediate risk, referral, medicine reconciliation and safe review without claiming a national psychotherapy or prescribing sequence.
The Bottom Line
- Confirm the pattern, duration and functional effect of low mood, loss of interest, sleep or appetite change, energy, concentration, guilt and hopelessness while considering grief, substance use, medicine effects and physical illness.
- Ask directly about suicidal thoughts, intent, planning, access to means, previous attempts, self-neglect and thoughts of harm to others; also assess psychosis, agitation and ability to maintain food, fluids, shelter and dependent care.
- Check for previous mania or hypomania, antidepressant-associated activation, postpartum mood change and a family history of bipolar disorder before treating the presentation as unipolar depression.
- Within Queensland rural and remote practice, use the current PCCM to consult the authorised medical or nurse-practitioner and mental-health pathway; outside Queensland, replace its contacts, authorities and referral destinations with the patient’s jurisdictional pathway.
- When reducing or ceasing an established antidepressant, plan an individual taper from duration, dose, prior withdrawal and relapse history, monitor emerging symptoms and distinguish withdrawal from recurrence rather than stopping abruptly by default.
Practical clinical workflow
1
Establish immediate physical stability, recent overdose or injury, mental state, substance exposure, pregnancy or postpartum status, current care plan and all prescribed, non-prescribed and recently stopped medicines.
2
Describe symptom trajectory and function, obtain collateral information with consent when useful and assess medical mimics with focused examination and investigations driven by the presentation.
3
Formulate current and foreseeable safety risks in words, agree supervision and a practical safety plan, and arrange emergency or specialist assessment when the person cannot remain safe.
4
For a stable presentation, agree the next clinical owner, the local psychological or psychiatric referral route and an early review that checks sleep, activation, suicidality, adherence, adverse effects and functional change.
5
If antidepressant discontinuation is being considered, explain possible withdrawal, make one planned change at a time, give a contact route for deterioration and document when taper, pause, reinstatement or specialist advice will be reconsidered.
Safety boundaries and escalation
- Imminent suicidal intent, a medically serious attempt, psychotic depression, catatonia, severe agitation, inability to eat or drink, or inability to protect a child or dependent requires urgent emergency and mental-health assessment.
- A reduced need for sleep with increased energy, pressured speech, grandiosity, disinhibition or marked activation after an antidepressant raises concern for mania or a mixed state and needs urgent diagnostic review.
- Pregnancy, the postpartum period and responsibility for an infant require explicit assessment of maternal and infant safety and use of the jurisdiction’s perinatal mental-health pathway.
- Abrupt antidepressant cessation can cause clinically important withdrawal; new suicidality, severe agitation, confusion or neurological symptoms during a taper warrants prompt reassessment rather than automatic attribution to relapse.
Implementation
The mood-disorders chapter used here is Queensland Health guidance for rural and remote practice, not a national Australian depression CPG. Its scope, authorised roles, mental-health contacts and involuntary-care processes apply in Queensland only. Australian Prescriber provides national, government-published stopping advice but not a complete depression-treatment algorithm. Every other state or territory must substitute its own acute mental-health and prescribing pathway.
Clinical use boundary
This independently written summary is not an official guideline. Check the linked source version, current TGA-approved product information where medicines are involved, and the applicable state, territory and local pathway at the point of care.
Source documents
Use the linked source documents for complete recommendations, evidence grading, exclusions and implementation detail.
- Queensland Health and Royal Flying Doctor Service Queensland SectionPrimary Clinical Care Manual, 12th edition: Mood disorders — adult/child (depression and bipolar)ISBN 978-1-876560-22-5 · 12th edition 2025, v1.03 with updates through 21 July 2026; section 5, printed pages 343–344 · accessed 2026-08-20view source
- Australian Prescriber, Australian Government Department of Health, Disability and AgeingStopping antidepressants: when and howDOI 10.18773/austprescr.2026.019 · Australian Prescriber 2026;49:99–103, published 2 June 2026 · accessed 2026-08-20view source
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