When should I consider referring a patient with SAD to a mental health specialist?

Consider referring a patient with seasonal affective disorder (SAD) to a mental health specialist if:

• They have more severe depression or chronic depressive symptoms that significantly impair personal and social functioning.
• They have not benefitted from previous treatments.
• They have multiple complicating problems such as unemployment, poor housing, or financial difficulties.
• They have significant coexisting mental or physical health conditions.

Referral should be for coordinated multidisciplinary care, including development of a multidisciplinary care plan with the patient and relevant professionals, crisis planning, and medication management as appropriate.

For less severe cases, initial management in primary care with stepped or matched care approaches is appropriate, reserving specialist referral for more complex or treatment-resistant cases.

This approach aligns with NICE guidance on depression management, which includes SAD under depressive disorders.

NICE NG222,NICE CG91