|Screening for Depression in Adults—Recommendations from the USPSTF|
| The US Preventive Services Task Force (USPSTF) recommends screening of depression in adults including pregnant and postpartum women with condition of adequate systems in place, where accurate diagnosis, effective treatment, and appropriate follow-up can be applied (here).
Background Depression, or major depression disorder (MDD), is one of the leading causes of disability in those who are 15 years and older, which has a negative influence in themselves, their families, work, and the whole society. Depression is also a common cause for clinic visits.
Screening population All adults (older than 18 years old) who have yet been screened previously should be screened. Screening methods Health practitioners can use the following screening methods to perform screening for depression: (1) Patient Health Questionnaire; (2) Hospital Anxiety and Depression Scale in Adults; (3) Geriatric Depression Scale in Older Adults; and (4) Edinburgh Postnatal Depression Scale in Postpartum and Pregnant Women. All positive screening results should be followed by further assessment, alternate diagnoses, and medical conditions.
Implementations Screening for depression should be executed with adequate systems in place, where patients with positive screening results can be appropriately diagnosed and treated with evidence-based therapy, and/or referred to a facility providing specialized health care.
Treatment Effective therapeutic options for depression in adults are antidepressants and/or psychotherapy (cognitive behavioral therapy, or brief psychosocial counseling). Given potential serious fetal harms from antidepressants, clinicians should consider cognitive behavioral therapy or other evidence-based counseling approaches when controlling depression in pregnant or breastfeeding women.
Potential harms Second-generation antidepressants (mostly selective serotonin reuptake inhibitors (SSRI)) are associated with some harms, like an increase in suicidal behaviors in those of 18 to 29 years, and an increase in upper gastrointestinal bleeding in those older than 70 years. Antidepressants in pregnant women have potential harms in fetuses. However, the overall magnitude of harms in small to moderate.
Other consideration It is worth noting that the Canadian Task Force on Preventive Health Care does not recommend routine screening for depression in adults with average risk or in those who may be at increased risk of depression.