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IMAGE The US Preventive Services Task Force (USPSTF) recommends 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 have 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, millions of Americans will be diagnosed with a mood disorder (major depressive, dysthymic, or bipolar disorder).
A number of people with the disorder do not even know they have it. Depression is often disguised by other problems. And, though the stigma tied to the disorder is easing, many who are affected still go undetected and untreated.

Screening Advice

The USPSTF urges primary care doctors to screen all adult patients for signs of depression and give them appropriate treatment and follow up care.

Depression Questions

According to USPSTF, the following two questions are a good place to start:
  1. Over the past two weeks, have you ever felt down, depressed, or hopeless?
  2. 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 check-up.

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:
  • Personal history of depression
  • Having another mental disorder
  • Family history of depression or spousal history of depression
  • Loss of a job
  • Recent loss of a loved one or miscarriage (for women)
  • Chronic medical illness, such as diabetes
  • Problems with sleep
  • Chronic pain
  • Current or past alcohol or drug abuse
  • Child abuse or neglect
  • Domestic violence or bullying
  • Financial stress

Diagnosis

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*
  • Reduced appetite and weight loss, or increased appetite and weight gain
  • Sleeping too little or sleeping too much
  • Feelings of restlessness or irritability, or feeling slowed down
  • Persistent feelings of decreased energy, tiredness, or listlessness
  • Frequently feeling guilty, hopeless, helpless, or worthless
  • 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.
Your doctor will also make sure that your symptoms are not being caused by other psychiatric or medical conditions.

Effective Treatment

Depression is very treatable. Research has 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" may be more effective than either alone. Alternative treatments, such as St. John's wort, are also being studied. 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. If you have thoughts of death or suicide, call your doctor right away. With better screening and medical care, the future looks brighter for adults with depression.

RESOURCES

American Psychiatric Association http://www.psych.org/

National Institute of Mental Health http://www.nimh.nih.gov/

CANADIAN RESOURCES

Canadian Mental Health Association http://www.cmha.ca/

Canadian Psychiatric Association http://www.cpa-apc.org/

References

Depression. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/. Updated June 28, 2012. Accessed July 23, 2012.

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 July 11, 2012.

Screening for depression in adult. U.S. Preventive Services Task Force website. Available at: http://www.uspreventiveservicestaskforce.org/uspstf/uspsaddepr.htm. Published December 2009. Accessed July 23, 2012.

The numbers count: Mental disorders in America. National Institutes of Public Health website. Available at: http://www.nimh.nih.gov/health/publications/the-numbers-count-mental-disorders-in-america/index.shtml . Updated June 2008. Accessed July 11, 2012.

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.

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