Depression Screening Advised for All Adults
The US Preventive Services Task Force (USPSTF) recommneds screening for depression in adults. What does this mean for you? The next time you have a doctor's appointment, you may be asked questions about your mental health.
Scope of the Problem
We’ve known for years that depression is a big problem. According to the National Institutes of Mental Health, major depressive disorder is the leading cause of disability in the US. In a given year, over 20 million Americans have a mood disorder (major depressive, dysthymic, or bipolar disorder). Depression decreases quality of life, increases healthcare costs, and contributes to billions of dollars in lost workdays per year. By 2020, experts expect depression to become the world’s second most debilitating ailment after heart disease.
And this is just the tip of the iceberg.
A huge number of people with the disorder don’t even know they have it. Depression is often disguised by other problems. And, though the stigma tied to the disorder is easing, up to half of those affected still go undetected and untreated.
New Screening Advice
In response to these problems, the USPSTF convened an expert panel to study the best ways to identify depression. The panel considered a number of recent studies and concluded that patients fare best when they’re routinely screened for depression and given appropriate medical care.
The USPSTF is now urging primary care doctors to regularly screen all adult patients for signs of depression.
According to USPSTF, the following two questions are a good place to start:
- Over the past two weeks, have you ever felt down, depressed, or hopeless?
- Over the past two weeks, have you felt little interest or pleasure in doing things?
If your answer is “yes” to either question, contact your primary care doctor for an evaluation. Your doctor may advise completing a more in-depth questionnaire or having a thorough checkup.
Risks for Depression
Research suggests depression comes from an imbalance of certain brain hormones. The disorder is more common in people who inherit a tendency for depression or are exposed to certain environmental triggers. Factors that can increase your chance of developing depression include:
- Being female
- Personal history of depression
- Having another mental disorder
- Family history of depression
- Loss of a job
- Recent loss of a loved one
- Chronic medical illness
- Multiple unexplained physical symptoms
- Sleep disorder
- Chronic pain
- Alcohol or drug abuse
- Child abuse or neglect
- Domestic violence
- Financial stress
If you suspect you suffer from depression, your doctor can make a diagnosis after a complete exam. The diagnosis requires having at least five symptoms for more than two weeks that are severe enough to interfere with your daily routine. The symptoms of depression include the following:
- Persistent sad, anxious, or empty feelings*
- Loss of interest or pleasure in activities that were once enjoyable*
- Frequently feeling guilty, hopeless, helpless, or worthless
- Persistent feelings of decreased energy, tiredness, or listlessness
- Sleeping too little or sleeping too much
- Reduced appetite and weight loss, or increased appetite and weight gain
- Feelings of restlessness or irritability, or feeling slowed down
- Difficulty thinking, concentrating, remembering, or making decisions
- Thoughts of death or suicide
*Either the first or second symptom on this list must be present for a diagnosis of depression.
Depression is very treatable. Research has conclusively shown that antidepressant drugs and counseling—alone or in combination—are effective in combating the disorder; however; the combination of "talk-therapy" and "drug therapy" is more effective than either alone. Studies are currently underway on several alternative remedies. And adjusting your lifestyle to include more exercise and social activities may help, as well.
You are encouraged to talk to your doctor if you have concerns about your mental health. With better screening and medical care the future looks brighter for adults with depression.
American Psychiatric Association
National Institute of Mental Health
Canadian Mental Health Association
Canadian Psychiatric Association
Diagnosis and management of depression. American Family Physician. 2000.
New recommendations for depression screening. Journal Watch website. Available at: http://general-medicine.jwatch.org/cgi/content/full/2002/604/1. Published May 2002. Accessed August 13, 2008.
The numbers count: Mental disorders in America. National Institutes of Public Health website. Available at: http://www.nimh.nih.gov/publicat/numbers.cfm. Updated June 2008. Accessed August 13, 2008.
US Preventive Services Task Force now finds sufficient evidence to recommend screening adults for depression [press release]. Agency for Healthcare Research and Quality. May 20, 2002.
US Preventive Services Task Force. Screening for depression in adults: Summary of the evidence. Ann Int Med. 2002;136:765-776.
US Preventive Services Task Force. Screening for depression: Recommendations and rationale. Ann Int Med. 2002;136:760-764.
Last reviewed June 2008 by Theodor B. Rais, MD
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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