Everett Schlam, MD, agrees. “Primary care physicians are ideally suited to diagnose and treat depression.”

Utilizing screening questionnaires such as the PHQ-9 will enable PCPs to “assess the diagnosis and severity of depression,” and incorporate awareness of other medical conditions into an overall treatment plan, said Dr. Schlam, who is an Assistant Professor, Department of Family Medicine, University of Medicine and Dentistry of New Jersey, and Professor and Chair, Department of Family Medicine, St. George’s University Medical School. He adds that it is also important to utilize the Mood Disorders Questionnaire (MDQ) to screen for bipolar disorder and differentiate it from unipolar depression.

Pharmacological vs Nonpharmacological Interventions: The AHRQ Review

The AHRQ’s Comparative Effectiveness Review set out to examine four key questions (KQs). (Table 2) After identifying 7,813 potential articles for review, the researchers selected 44 trials that met all eligibility requirements and included data from 85 additional published trials and 27 unpublished trials that provided common comparators, which were used for network meta-analysis.  The population examined were adult (>18 years) outpatients of all races and ethnicities with MDD during either an initial treatment attempt, or a second treatment attempt in patients who did not have remission following an initial adequate trial with an SGA. The interventions studied are found in Table 3. Key findings are summarized below:

Second-generation antidepressants (SGAs) vs cognitive behavioral therapy (CBT): “Moderate” evidence regarding the comparative benefits showed that SGAs and CBT have similar effectiveness regarding symptomatic relief in patients with mild to severe MDD. After 24 weeks of follow-up, however, SGAs led to higher rate of overall discontinuation due to adverse events than did CBT. Adding CBT to SGA did not show any benefit in remission response.

SGAs vs alternative/complementary therapies: “Moderate” evidence regarding the risk of harm between SGAs versus CBT, acupuncture and St. John’s wort demonstrated that patients treated with SGAs had a higher risk of experiencing adverse events or discontinuing treatment because of adverse events than did patients treated with CBT, acupuncture, or St. John’s wort. However, the evidence was insufficient to draw conclusions about serious adverse events, such as suicidal ideas or behavior.