March 1st, 2016

Task force recommends depression screening for adults

Adults, including pregnant and postpartum women, should be annually screened for depression, according to a recommendation by the U.S Preventive Services Task Force.

The organization cited the prevalence of major depressive disorder among adults in high income countries, its impact on quality of life for patients and their families and the higher risk of death by suicide or an inability to control other health issues.

The USPSTF commissioned a systematic review to update a 2009 recommendation that focused on the direct evidence about the benefits and harms of depression screening.

The organization also reviewed the accuracy of depression screening instruments.

Diego Pizzagalli, Ph.D., director of the Center for Depression, Anxiety and Stress Research at McLean Hospital and a professor of Harvard Medical School said that he “wholeheartedly supports,” the recommendation.

Noting that patients are screened for other diseases such as diabetes and vascular issues, he feels it is appropriate that “this first necessary step” be taken towards planning intervention.

“As a society, we need to embrace the idea that depression is not a personality flaw. It is a disease. My hope is that (acceptance) of this concept will make the stigma go away,” he said.

Pizzagalli said that the stigma surrounding mental illnesses that keeps people from seeking help is “frustrating,” for those working in the field.

The Center was founded in 2010 with the goal to understand the causes of depression and how it is manifested in the brain.

He explained that researchers use neuro imaging to study brain diseases and identify who is at risk so that interventions can be made and one day, onset can be prevented.

“Depression is a powerful disease with many effects on the brain and body,” Pizzagalli said. “It is similar to other disorders that can be identified, treated and cured.”

The task force report noted that implementation of the screening needs to take place with “adequate systems” in place. That term refers to clinical staff, such as a nurse, administering a questionnaire to the patient. If the individual tests positive, the primary care doctor would discuss the results and recommend a specialist for treatment.

Effective treatment of depression generally includes antidepressants and psychotherapy approaches like cognitive behavioral therapy alone or in combination.

Because of the risk of fetal harm, non-pharmaceutical methods are more appropriate for pregnant women, Pizzagalli said.

Philip Levendusky, Ph.D., ABPP is also in favor of the annual screening.

He is director of the psychology department, co-director of psychology training at McLean Hospital and an associate professor of psychology at Harvard Medical School.

“It’s an extremely good idea. The probability of depression is quite high,” he said. “The more we talk about things in a benign environment – such as a primary doctor’s office – the more people will feel free to express concerns. That’s fantastic.”

He noted that patients are already asked questions like “Do you feel safe at home?” or “Have you fallen in the last three months?”

Adding a psychiatric questionnaire makes sense, Levendusky said.

He is glad the recommendation specifies giving pregnant and postpartum women the opportunity to express their feelings.

“It’s a very vulnerable time for them. They think they should be happy and they feel badly if they aren’t and nobody asks why,” Levendusky said. “This (screening) sends a helpful message that it is okay to talk about it.”

Inclusion of older patients is “just as appropriate,” Pizzagalli said. Geriatric patients are particularly susceptible to depression because it is a time in their lives when they have lost spouses, family members and friends and are experiencing more physical ailments and social isolation.

The next step for health care as a field is to evaluate and recognize the close relationship between physical and mental health, Levendusky said. Embedding both fields inside clinical settings, “unheard of five years ago,” would be a “constructive,” approach.

By Susan Gonsalves

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