Primary care doctors should screen for depression, panel says

Female doctor holding application form while consulting patient

U.S. adults should be screened for depression, according to a proposal from a government-backed panel of medical experts.

With this proposal, the U.S. Preventive Services Task Force broadens its 2009 recommendation that adults be screened in doctors' offices if staff-assisted depression care is available.

"We believe all clinical practices should be able to put those systems in place," said Dr. Kirsten Bibbins-Domingo, the USPSTF's co-vice chair.

"This is a recommendation to screen all adults in the primary care setting, including pregnant and postpartum women," said Bibbins-Domingo, who is also affiliated with the University of California, San Francisco.

About 7 percent of people in the U.S. met criteria for a depressive disorder between 2009 and 2012, according to a review of evidence the panel conducted before making its proposal.

The benefits of effective screening and treatment for depression in the U.S. population are likely significant, Bibbins-Domingo told Reuters Health.

Doctors can screen for depression in their offices using the nine-question Patient Health Questionnaire.
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"The majority of people are not depressed, but some people are – especially in the postpartum period," said Dr. Renée Binder, president of the American Psychiatric Association.

"It’s very important to identify that something is going on and get effective treatment," said Binder, who is also associate dean of academic affairs at the School of Medicine at the University of California, San Francisco.

Binder was not involved with the proposed recommendation.

Treatments for depression include antidepressant medications, psychotherapy or both, according to the recommendation.

The benefits of effective treatment among women may be especially important, according to Myrna Weissman of Columbia Psychiatry and the New York State Psychiatric Institute in New York City.

"There is good data showing now that if a woman is depressed and you can treat her that you will have a big effect on her children," said Weissman, who was not involved with the proposed recommendation.

It's important, she added, that doctors who screen for depression must also have time to treat and manage people who need it.

"Depression screening should be routine the way you screen for hypertension (high blood pressure) and diabetes as part of a routine clinic visit, but there has to be time to deal with a positive response," Weissman said. "That includes time to sort out what brought it on and the severity."

The new USPSTF proposal is a grade B recommendation, which means there is at least moderate certainty the benefit will be moderate to substantial.

Under the Affordable Care Act, better known as Obamacare, grade A and B recommendations from the USPSTF are covered without cost to the patients.

Specifics of that coverage are up to the individual insurers, Bibbins-Domingo said.

The USPSTF's proposal will be open for public comment until August 24.