Depression Screening and Management: New Recommendations and Treatment Analysis

Table 1
USPSTF Screening Recommendations for Depression in Adults
Risk assessment
  • Increased/high risk
  • Women
  • Young/middle aged adults
  • Undereducated
  • Previous married
  • Unemployed
  • Chronic illnesses
  • Other mental health disorders
  • Family history of psychiatric disorders
  • Older adults
  • Disability
  • Poor health status related to medical illness
  • Complicated grief
  • Chronic sleep disturbance
  • Loneliness
  • History of depression
  • Pregnancy/postpartum
  • Poor self-esteem
  • Childcare stress
  • Prenatal anxiety
  • Life stress
  • Decreased social support
  • Single/unpartnered relationship status
  • History of depression
  • Difficult infant temperament
  • Previous postpartum depression
  • Lower socioeconomic status
  • Unintended pregnancy
Screening Tests
  • Patient Health Questionnaire (PHQ) in various forms
  • Hospital Anxiety and Depression Scales (HADS) in adults
  • Geriatric Depression Scale (GDS) in older adults
  • Edinburgh Postnatal Depression Scale in postpartum/pregnant women
  • Positive screening results should lead to additional assessment that considers severity of depression, comorbid psychological problems, alternate diagnoses, and medical conditions
Screening interval
  • Optimal screening interval unknown
  • Screen all previously un-screened adults
  • Use clinical judgment in consideration of risk factors, comorbid conditions, and life events to determine if additional screening of high-risk patients is warranted
Treatment and interventions
  • Antidepressants
  • Specific psychotherapy approaches
  • Combination of antidepressants and psychotherapy
  • Evidence-based counseling interventions when managing depression in pregnant or breastfeeding women
Balance of benefits and harms
  • The net benefit of screening for depression in the adult population is moderate
Siu et al. JAMA. 2016 Jan 26;315(4):380-7.

Table 2
AHRQ Review: Scope and Key Questions
  • In adult patients with MDD who are undergoing an initial treatment attempt, what is the effectiveness of second-generation antidepressant (SGA) monotherapy, compared with the effectiveness of either nonpharmacologic monotherapy or combination therapy (involving nonpharmacologic with or without an SGA)?
  • Does comparative treatment effectiveness vary by MDD severity?
  • In adult patients with MDD who did not achieve remission following an initial adequate trial with one SGA, what is the comparative effectiveness of second-step therapies?*
  • Does comparative treatment effectiveness vary by MDD severity?
  • In adult patients with MDD, what are the comparative risk of harm of these treatment options for—
    • those undergoing an initial treatment attempt?
    • those who did not achieve remission following an initial adequate trial with an SGA?
  • Do the comparative risks of treatment harms vary by MDD severity?
KQ4 Do the benefits and risks of harms of these treatment options differ by subgroups of patients with MDD defined by—
  • Common accompanying psychiatric symptoms (coexisting anxiety, insomnia, low energy, or somatization)?
  • Demographic characteristics (age, race, or ethnicity)?
AHRQ, 2015

Table 3
AHRQ Interventions Included in Review
Second-generation antidepressants
  • Bupropion
  • Citalopram
  • Desvenlafaxine
  • Duloxetine
  • Fluoxetine
  • Escitalopram
  • Fluvoxamine
  • Levomilnacipran
  • Mirtazapine
  • Nefazodone
  • Paroxetine
  • Sertraline
  • Trazodone
  • Venlafaxine
  • Vilazodone
  • Vortioxetine
Common depression-focused psychotherapies
  • Behavioral therapies/behavior modification
  • Cognitive behavioral therapies
  • Integrative therapies (eg, interpersonal therapy)
  • Psychodynamic therapies
  • Third-wave cognitive behavioral therapies
Complementary and alternative medicines
  • Acupuncture
  • Meditation (eg, mindfulness-based stress reduction)
  • Omega-3 fatty acids
  • S-adenosyl-L-methionine (SAMe)
  • St. John’s wort (Hypericum perforatum)
  • Yoga
  • Any formal exercise program
Pharmacotherapies for combination or augmentations
  • Atypical antipsychotics
  • Psychostimulants
  • Buspirone
  • Levothyroxine (T4)
  • Lithium
  • Pindolol
  • Triiodothyronine (T3)
Control interventions
  • For all populations of interest
    • SGAs vs psychotherapies
    • SGAs vs CAM
    • SGAs vs exercise
    • SGAs vs SGA + CAM
    • SGAs vs SGA + exercise
    • SSGAs vs combination of interventions
  • For populations who did not have remission following adequate trial with SGA interventions—
    • SGA switch vs SGA switch
    • SGA switch vs nonpharmacologic treatment
    • SGA switch vs SGA augmentation
    • SGA augmentation vs SGA augmentation
    • SGA augmentation vs nonpharmacologic treatment
  • Benefits (eg, response to treatment, remission, speed of response, relapse, quality of life)
  • Harms (eg, overall adverse events, serious adverse events, specific adverse events, drug interactions)
AHRQ, 2015