What is the diagnosis and treatment for a patient with a Patient Health Questionnaire-9 (PHQ-9) score of 8 and Generalized Anxiety Disorder 7-item scale (GAD-7) score of 7, indicating mild depression and mild anxiety, with symptoms including little interest or pleasure in activities, trouble sleeping, fatigue, poor appetite, nervousness, and irritability?

Diagnosis and Treatment for Mild Depression and Mild Anxiety

This patient meets criteria for mild major depressive disorder (PHQ-9 score 8) and mild generalized anxiety disorder (GAD-7 score 7), requiring active monitoring with consideration for low-intensity interventions and reassessment in 2-4 weeks to determine if symptoms progress or functional impairment worsens. 1, 2, 3

Diagnostic Assessment

Primary Diagnoses

• Mild Major Depressive Disorder: PHQ-9 score of 8 falls in the 5-9 range, indicating mild depression with symptoms including anhedonia (little interest/pleasure in activities), sleep disturbance, fatigue, and appetite changes 1, 3
• Mild Generalized Anxiety Disorder: GAD-7 score of 7 falls in the 5-9 range, indicating mild anxiety with symptoms including nervousness, uncontrollable worry, restlessness, and marked irritability (nearly every day) 1, 3
• The co-occurrence of both conditions is common and expected, as depression and anxiety frequently present together 2, 4

Critical Safety Screening Required

• Immediate assessment for suicidal ideation, self-harm thoughts, or intent to harm others is mandatory - this patient denies suicidal thoughts, which is reassuring, but this must be explicitly documented and reassessed at each visit 1, 2
• Screen for severe agitation, psychotic symptoms, or confusion/delirium, as these would warrant urgent psychiatric referral 1, 2

Functional Impairment Assessment

• Determine specifically how symptoms interfere with work performance, home responsibilities, and interpersonal relationships 1, 2
• Ask about concrete examples: missing work days, avoiding social situations, difficulty completing household tasks, or relationship conflicts 2
• With mild severity scores, functional impairment is typically minimal to mild, but this must be explicitly assessed to guide treatment intensity 1, 2

Essential Comorbidity Screening

• Substance use assessment is critical: Ask specifically about alcohol consumption patterns, cannabis use, and other substances, as substance use disorders complicate anxiety/depression management and require concurrent treatment 1, 2
• Screen for other chronic medical conditions that may contribute to symptoms 1, 2
• Assess family history of mood or anxiety disorders 1, 2
• Evaluate for other anxiety disorders including panic attacks (discrete episodes of intense fear with physical symptoms) or social phobia 1, 5

Treatment Algorithm for Mild Severity

Pathway for PHQ-9 Score 5-9 and GAD-7 Score 5-9

Step 1: Active Monitoring and Psychoeducation

• For mild symptomatology with minimal functional impairment, initial management focuses on watchful waiting with structured follow-up 1
• Provide education about depression and anxiety symptoms, natural course, and when to seek additional help 2
• Assess current coping strategies and social support systems 1, 2

Step 2: Low-Intensity Interventions to Consider

• Guided self-help materials and resources for managing depression and anxiety 2
• Sleep hygiene education, given the prominent sleep disturbance (nearly every day) 1
• Behavioral activation strategies to address anhedonia and fatigue 2
• Relaxation techniques and stress management for anxiety symptoms 2

Step 3: Pharmacotherapy Consideration

• For mild depression (PHQ-9 5-9), provider clinical judgment determines whether to initiate antidepressant treatment based on symptom duration and functional impairment 1
• If symptoms have been present for extended duration (≥2 weeks of nearly daily symptoms) or if functional impairment is present despite being "mild," consider initiating an SSRI 1, 5
• Sertraline is FDA-approved for major depressive disorder and multiple anxiety disorders (panic disorder, social anxiety disorder, PTSD, OCD), making it an appropriate first-line choice when treating comorbid depression and anxiety 5
• Typical starting dose: sertraline 25-50 mg daily, with titration based on response and tolerability 5

Step 4: Structured Follow-Up Schedule

• Reassess in 2-4 weeks using PHQ-9 and GAD-7 to track symptom trajectory 1, 2
• If scores increase to moderate range (PHQ-9 ≥10 or GAD-7 ≥10), escalate to referral for psychology/psychiatry 1, 2
• If symptoms persist at mild level beyond 8-12 weeks despite low-intensity interventions, consider initiating pharmacotherapy or referring for psychotherapy 1, 2

Indications for Immediate Escalation to Specialty Care

• If moderate to severe symptoms are detected (PHQ-9 ≥10 or GAD-7 ≥10), refer to psychology/psychiatry for formal diagnostic assessment and treatment 1, 2
• GAD-7 score of 10-14 indicates moderate anxiety requiring specialist involvement per guidelines 1, 2
• PHQ-9 score of 10-14 indicates moderate depression requiring further diagnostic assessment 1, 3

Critical Clinical Pitfalls to Avoid

Overlooking Comorbid Conditions

• Do not miss substance use disorders - they require concurrent treatment and significantly complicate anxiety/depression management 1, 2
• The high correlation between PHQ-9 and GAD-7 scores (correlation coefficient 0.74) means treating one condition often improves the other, but both must be monitored 4

Inadequate Safety Monitoring

• Reassess suicide risk at every visit, especially if initiating antidepressant medication 5
• Sertraline carries FDA black box warning for increased suicidal thoughts/actions in children, adolescents, and young adults, particularly in first few months of treatment or with dose changes 5
• Monitor for serotonin syndrome if combining with other serotonergic agents 5

Premature Treatment Decisions

• With mild severity and unclear functional impairment, avoid rushing to pharmacotherapy without adequate assessment of symptom duration and impact 1
• However, do not delay treatment if symptoms have been chronic (present for months) or if functional impairment is underreported 1, 2

Loss to Follow-Up

• Mild symptoms can progress to moderate/severe without structured monitoring 1, 2
• Schedule specific follow-up appointments rather than advising patients to "call if worse" 2

Monitoring Treatment Response

• Use PHQ-9 and GAD-7 at each visit to objectively track symptom changes 1, 3
• If pharmacotherapy is initiated, reassess at 2-4 weeks for early response and side effects 5
• Full antidepressant response typically requires 6-8 weeks at therapeutic dose 5
• Monitor for treatment-emergent symptoms including increased anxiety, agitation, or mood changes 5