The Effective Management of Mood Disorders in Primary Care - Part I

The US Preventive Services Task Force found good evidence that screening improves the accurate identification of depressed patients in primary care settings and that treatment of depressed adults identified in primary care settings decreases clinical morbidity. Trials that have directly evaluated the effect of screening on clinical outcomes have shown mixed results.Small benefits have been observed in studies that simply feed back screening results to clinicians. Larger benefits have been observed in studies in which the communication of screening results is coordinated with effective followup and treatment. The USPSTF concluded the benefits of screening are likely to outweigh any potential harms.

If this recommendation from the USPSTF isn’t enough to convince you that you should be screening for depression in your practice, consider these statistics:

Depression: The Cost to Society

• Depression results in 18 million office visits per year
• 100 million prescriptions are written for depression each year
• Depression is a clinical paradox — only one of three patients are accurately diagnosed
• Depression has a lifetime prevalence of 17%
• There are eight million cases of major depressive disorder per year in the United States

Who gets depressed?

• Onset typically occurs in early adulthood, between the ages of 20 and 40
• Women are twice as likely to suffer from depression
• A family history of depression makes an individual 1 1/2 to three times more likely to suffer from it
• Up to 1 in 10 mothers suffer from post partum depression

Marital status also affects depression: Individuals who are divorced, separated, or widowed are more likely to be depressed. Interestingly, married men are less likely to be depressed than single men, while single women are less depressed than married women.

If an individual has a personal history of depression:

• One episode indicates a 50% likelihood of relapse
• After two episodes, the likelihood of relapse increases to 75%
• After a third episode, there is a 90% chance that an individual will relapse

A chronic medical illness significantly ratchets up a patient’s chance of depression (diabetes doubles the risk of depression). Further, untreated depression in these cases leads to very bad outcomes in treatment for patients with conditions such as acute coronary events, diabetes, and HIV.

The pervasive and insidious nature of depression is quite evident through these statistics. At the very least, they highlight the likelihood that you are or will be seeing a patient suffering from depression. In order to ensure that this suffering does not go unnoticed, you should be screening for it.

Part II will tell you how...