The United States Preventive Services Task Force (USPSTF) has published an update (1) of their recommendations for screening for depression in adults seen in a primary care office. You might assume that screening for depression is always a good thing until you realize that it will help only those whose depression would not otherwise be detected by their medical clinician. These cases of “screen-detected depression” tend to be milder than “clinician-detected depression”, they may not need treatment and they might not respond as well to medication. In addition, about half of patients given medication for depression in primary care stop taking it in less than three months which limits the effectiveness and increases the relapse rate of their illness. This reduces the benefit of screening.
Another important consideration is the potential for harm associated with treating depression. There is a small short-term increase in suicide attempts among younger patients (age 18-29) with major depressive disorder who are treated with medication of the SSRI class (particularly paroxetine). SSRI medication also slightly increases the risk of gastrointestinal bleeding in older adults (age 50+), particularly if they are also regularly taking anti-inflammatory medication (such as ibuprofen, naproxen or even aspirin).
After considering the above issues (and a few others), the USPSTF concluded that screening for depression should be provided only “when staff-assisted depression care supports are in place to assure accurate diagnosis, effective treatment and follow-up.” With the support of well-trained staff, the busy primary care practitioner won’t need to take on the entire burden of evaluating the patient, monitoring treatment and checking for suicidal thoughts. Such programs do appear to reduce the burden of depression in the months and years after diagnosis.
1. USPSTF. Screening for Depression in Adults. Annals of Internal Medicine 151: 784 – 792. Dec, 2009.
Tags: depression
