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
KQ1		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?
KQ2		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?
KQ3		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
Exercise		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
Outcomes		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