Mount Carmel Health Partners Clinical Guidelines Major Depression

Major Depression Clinical Guideline Definition: Major depression (major depressive disorder) is defined as an episode consisting of 5 or more symptoms (see Table 3), lasting for most of the day, nearly every day, for a minimum of 2 consecutive weeks, with at least one symptom to be either loss of interest/pleasure or depressed mood. Diagnosing Initial Major Depression Screen patient annually using the PHQ-2 tool (page 4). If screen is positive or clinical suspicion, administer a more specific screening tool: • Geriatric Depression Scale (page 4) • PHQ-9 (page 7) • Edinburgh Postnatal Depression Scale (page 6) Continue algorithm if second screen is positive. Evaluation Treatment Assess for bipolar disorder (MDQ Scale is suggested; see page 9) Positive Treat for bipolar disorder Negative • Assess for substance misuse or psychiatric comorbidity (i.e. Audit or DUST Scale) • Perform physical exam including cognitive assessment. No Does patient have suicidal or homicidal ideations? Yes · Use SAD PERSONS Scale (page 4) to ask patient about intent, plan, available means. · Have a low threshold to access emergent evaluation. · Consider referral to psychiatrist and/or hospital admission. Yes Are there additional considerations? (medical comorbidities) No Create treatment plan with shared decision-making: • Collaborative care model • Educate and engage patient • Discuss treatment options: ◦ Psychotherapy ◦ Pharmacotherapy ◦ Both Yes Address secondary causes and/or adapt a plan for the special population; rule out malingering. See next page May 2018