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