All adults in the U.S., including pregnant and postpartum women, should be screened for depression when they visit the doctor, according to new recommendations released by a government-appointed panel.
This recommendation from the U.S. Preventive Services Task Force (USPSTF) is largely consistent with the group's previous recommendation, which was issued in 2009, said Karina Davidson, a member of the task force and a professor at Columbia University Medical Center. However, at the time the previous recommendation was made, there was not enough evidence for the group to either recommend or discourage depression screening for pregnant and postpartum women, she said.
The USPSTF makes recommendations regarding the effectiveness of preventive health services, and also considers whether the benefits of treatments outweigh the potential risks.
"The task force has determined that there is enough good-quality evidence to be confident that the benefits of screening for depression outweigh the harms for the general adult population, including pregnant and postpartum women,"Davidson said. "This is because we found evidence that screening for depression in the primary care setting is accurate, that treatment for depression is effective for people detected through screening and the likelihood of harms from screening or treatments are small."
The USPSTF issued a "B grade recommendation" for depression screening, meaning that it is of moderate to substantial net benefit. The recommendations were published today (Jan. 26) in the Journal of the American Medical Association.
Screening and treatment
Depression screening typically involves questionnaires, such as the Patient Health Questionnaire, the Hospital Anxiety and Depression Scale, the Geriatric Depression Scale in older adults, and the Edinburgh Postnatal Depression Scale in postpartum and pregnant women. People who get a positive screening result (meaning they may possibly have depression) would then undergo additional assessments — for example, to determine their medical condition, consider alternative diagnoses or assess the severity of their possible depression. [7 Ways Depression Differs in Men and Women]
The new guidelines recommend that all people age 18 and older be screened for depression. However, the optimal timing of when the screening should begin and how often people should be screened are not known, the task force said.
For doctors, a practical approach might include screening all adults who have not been screened previously, and using their clinical judgment to consider a patient's risk factors, other health conditions and life events to determine if additional screening is warranted, the task force said.
Depression can be treated with "talk therapy," such as cognitive behavioral therapy, and also with antidepressant medications, the panel said.
The new recommendation now includes pregnant and postpartum women because recent evidence suggests that cognitive behavioral therapy and other types of talk therapy can help pregnant women suffering from depression and women with postpartum depression, Davidson told Live Science.
According to a recent survey from the Centers for Disease Control and Prevention, 8 to 19 percent of women reported having frequent postpartum depressive symptoms, and up to 8 percent of pregnant women reported having depression, according to findings published in 2012 in the Journal of Women's Health.
The use of antidepressant medications during pregnancy could harm a fetus, but the risk of harm is small, Davidson noted. More research is needed to determine both the risks and benefits — for women as well as their fetuses — that may come with using these drugs during pregnancy, she said.
The panel also noted that there is an increased risk of suicide associated with the use of some second-generation antidepressants (such as selective serotonin reuptake inhibitors). These drugs also increase the risk of upper gastrointestinal bleeding in adults over 70.
However, some experts not on the panel expressed concerns about the recommendations.
For example, the recommendations do not include "effective treatment and appropriate follow-up," Dr. Charles F. Reynolds III and Ellen Frank, both psychiatry professors at the University of Pittsburgh, wrote in an editorial about the recommendations.
The recommendations do not put enough emphasis on major depression as a recurring, chronic condition for the majority of patients who have the condition, Reynolds and Frank wrote. [7 Ways to Recognize Depression in 20-Somethings]
In another editorial, Dr. Helen S. Mayberg, a professor of psychiatry, neurology and radiology at the Emory University School of Medicine, said that neurologists should play a larger role in diagnosing and treating patients with depression — particularly patients with depression who may be reluctant about receiving psychiatric treatment.
Only 40 percent of patients suffering from depression get better with their first treatment, which is typically through an antidepressant medication or evidence-based psychotherapy, Mayberg noted.
Treatments that don't work are harmful to patients because they add stress and increase the risk of suicide, and two to three months of ineffective treatment is also linked to a loss of productivity and wasted resources, Mayberg said. More investigation of brain-based biomarkers and brain imaging could help predict how patients will respond to treatments, she suggested.
Among all mental health disorders, major depression carries the heaviest burden of disability, meaning that no other disorder results in a greater loss of healthy years of life, according to the World Health Organization.
Depression is also the most common mental disorder in the United States, according to the National Institute of Mental Health.
The two most essential components of the recommendation have remained unchanged since the 2009 report, including the use of a reliable, patient-reported screening test for depression, as well as the panel's belief that screening can lead to an accurate diagnosis and treatment in primary care, Davidson said.
For the future, Davidson said the panel is looking at ways that primary care physicians — who might not be trained in evidence-based mental health treatments —might best implement services to help their patients.