The active management of depression - Clinical Update

Journal of Family Practice,  Sept, 2002  by Larry Culpepper

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TABLE 1

Screening for depression

Outpatient adults (United States Preventive Services Task Force)

* Over the past 2 weeks, have you felt down or hopeless?

* Over the past 2 weeks have you felt little interest in doing things?

A positive response to either question should be followed by a more
in-depth interview to confirm or refute the diagnosis.

Postpartum women (Edinburgh Postnatal Depression Scale) *

1. I have been able to laugh and see the funny
   side of things

-- As much as I always could (0)
-- Not quite so much now (1)
-- Definitely not so much now (2)
-- Not at all (3)

2. I have looked forward with enjoyment
   to things

-- As much as I ever did (0)
-- Rather less than I used to (1)
-- Definitely less than I used to (2)
-- Hardly at all (3)

3. I have blamed myself unnecessarily when
   things went wrong

-- Yes, most of the time (3)
-- Yes, some of the time (2)
-- Not very often (1)
-- No, never (0)

4. I have been anxious or worried for no
   good reason

-- No, not at all (0)
-- Hardly ever (1)
-- Yes, sometimes (2)
-- Yes, very often (3)

5. I have felt scared or panicky for no very
   good reason

-- Yes, quite a lot (3)
-- Yes, sometimes (2)
-- No, not much (1)
-- No, not at all (0)

6. Things have been getting on top of me

-- Yes, most of the time I haven't been able
   to cope at all (3)
-- Yes, sometimes I haven't been coping
   as well as usual (2)
-- No, most of the time I have coped quite well (1)
-- No, I have been coping as well as ever (0)

7. I have been so unhappy that I have had
   difficulty sleeping

-- Yes, most of the time (3)
-- Yes, sometimes (2)
-- No, not very often (1)
-- No, not at all (0)

8. I have felt sad or miserable

-- Yes, most of the time (3)
-- Yes, quite often (2)
-- No, not very often (1)
-- No, not at all (0)

9. I have been so unhappy that I have
   been crying

-- Yes, most of the time (3)
-- Yes, quite often (2)
-- No, only occasionally (1)
-- No, never (0)

10. The thought of harming myself has occurred
to me

-- Yes, quite often (3)
-- Sometimes (2)
-- Hardly ever (1)
-- Never (0)

* Reprinted with permission, from Cox JL et al. British Journal of
Psychiatry. 1987; 150:782-786.
TABLE 2

Key messages for patient education
about depression

* Antidepressants work only if taken every day

* Antidepressants are not addictive

* Benefits from medication appear slowly over
several weeks

* Continue antidepressants even after you feel better

* Mild side effects are common and usually improve
with time

* If you are thinking of stopping the medication, call
your physician first

* The goal of treatment is compete remission, but this
sometimes takes several medication adjustments

REFERENCES

(1.) Young AS, Klap R, Sherbourne CD, Wells KB. The quality of care for depressive and anxiety disorders in the United States. Arch Gen Psychiatry. 2001;58:55-61.

(2.) Institute of Medicine (U.S.). Committee on Health and Behavior: Research Practice and Policy. Health and Behavior: The Interplay of Biological, Behavioral, and Societal Influences. Washington, DC: National Academy Press. 2001.