From the Guidelines
To screen for depression, healthcare providers should ask patients about key symptoms using validated tools like the Patient Health Questionnaire-9 (PHQ-9) or the two-question PHQ-2 screener, with essential screening questions including: "Over the past 2 weeks, have you felt down, depressed, or hopeless?" and "Over the past 2 weeks, have you felt little interest or pleasure in doing things?" These questions are recommended by the US Preventive Services Task Force 1, 2, 3, 4, 5, 6 as an effective way to identify adults with depression. The use of these simple questions can be as effective as more formal instruments in identifying depression, especially in older adults 1. If these initial questions suggest possible depression, follow-up questions should assess sleep disturbances, changes in appetite or weight, fatigue, feelings of worthlessness or guilt, difficulty concentrating, psychomotor changes (agitation or slowing), and thoughts of death or suicide. The suicide risk question is particularly important: "Have you had thoughts that you would be better off dead or of hurting yourself in some way?" When implementing depression screening, providers should ensure privacy, use a non-judgmental approach, and have resources ready for positive screens. Depression screening is important because many patients don't spontaneously report symptoms, and early identification leads to better outcomes. Regular screening is recommended for all adults, especially those with risk factors or chronic conditions, with the frequency determined by clinical judgment and patient circumstances. Key considerations include the patient population being served and the practice setting, as there is little evidence to recommend one screening method over another 1, 2, 3, 4, 5, 6. All positive screening tests should trigger full diagnostic interviews that use standard diagnostic criteria to determine the presence or absence of specific depressive disorders, such as major depressive disorder (MDD) or dysthymia, and to address the severity of depression and comorbid psychological problems. Treatment may include antidepressants or specific psychotherapeutic approaches, such as cognitive behavioral therapy or brief psychosocial counseling, alone or in combination, and should be tailored to the individual patient's needs and circumstances. In treating patients, clinicians should consider the potential risks and benefits of different treatment options, including the increased risk for suicidal behavior associated with the use of selective serotonin reuptake inhibitors (SSRIs) in younger adults and the increased risk for upper gastrointestinal (UGI) bleeding associated with the use of SSRIs in older adults 1, 2, 3, 4, 5, 6.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Screening for Depression
To screen for depression, several questions can be asked to assess an individual's mental health. While the provided studies do not directly address specific screening questions, they highlight the importance of diagnosing and treating depression.
- The studies focus on the treatment of depression using selective serotonin reuptake inhibitors (SSRIs) 7, 8, 9, 10 and cognitive-behavioral therapy (CBT) 11.
- They discuss the efficacy and tolerability of SSRIs in treating major depressive disorder (MDD) 8, 9, 10.
- One study compares the effectiveness of fluoxetine, CBT, and their combination in treating adolescents with depression 11.
Assessment of Depression
Although the studies do not provide specific screening questions, they emphasize the need for a thorough assessment of depression.
- The Treatment for Adolescents With Depression Study (TADS) used the Children's Depression Rating Scale-Revised to assess depression severity 11.
- Another study used a neurocognitive test battery to assess cognitive domains in patients with MDD 9.
- These assessments can help identify individuals with depression and guide treatment decisions.
Importance of Screening
Screening for depression is crucial to provide timely and effective treatment.