Depression Screening and Management: New Recommendations and Treatment Analysis
The last two months have witnessed increased focus on depression by two major entities. In December, 2015, the Agency for Healthcare Research and Quality (AHRQ) issued a Comparative Effectiveness Review1 entitled “Nonpharmacological Versus Pharmacological Treatments for Adult Patients with Major Depressive Disorder.” And in January, 2016,2 the US Preventive Services Task Force (USPSTF) issued new recommendations for screening adults for depression.
The 2016 USPSTF Screening Recommendations
The USPSTF recommends “screening for depression in the general adult population (>18 years old), including pregnant and postpartum women.” This conclusion was reached “with at least moderate certainty that there is a moderate net benefit to screening for depression in all adults, including older adults, who receive care in clinical practices that have adequate systems in place to ensure accurate diagnosis, effective treatment, and appropriate follow-up after screening.”
The new recommendations are an update to the 2009 statement that recommended “screening all adults when staff-assisted depression supports are in place” and “selective screening based on professional judgment and patient preferences when such support is not available.” Since this type of support is “now much more widely available and accepted as part of mental health care,” that statement was omitted in the 2016 recommendations.
Additionally, the current statement specifically recommends screening for depression in pregnant and postpartum women. These populations were not specifically reviewed for the 2009 statement.
A summary of the recommendations can be found in Table 1.
In an accompanying editorial,3 Michael Thase, MD, Professor of Psychiatry, University of Pennsylvania, in Philadelphia, praised the USPSTF's statement. “The USPSTF's updated recommendations, which emphasize both newer-generation antidepressants and empirically supported psychotherapies, either singly or in combination, make good clinical sense and are fully consistent with contemporary North American practice guidelines.”
He noted the importance of primary care in implementing the recommendations. “In the United States, like many other economically developed nations, primary care practices represent the best place for implementation of these methods, because it is the only venue where both screening and, if clinically indicated, treatment can be provided.”