Which patients are at greater risk of major depression?Īnyone with a past depressive episode is at risk of further episodes, as the natural course of major depression involves frequent relapses.( 5) There is a bidirectional relationship between major depression and chronic disease. The clinical practice guidelines on major depression published by the Ministry of Health, Singapore, in 2012 recommend screening for major depression in high-risk persons where the benefits outweigh the risks.( 9) The United States Preventive Services Task Force recommends screening for major depression in the general adult population and having adequate systems in place to ensure proper diagnosis, treatment and follow-up.( 10) While the Canadian Task Force on Preventive Healthcare does not recommend routine screening of adults in primary care, it advocates vigilance for major depression in patients with risk factors and symptoms of insomnia, low mood, anhedonia and suicidal thoughts.( 11) The 2016 updated guidelines from the National Institute for Health and Care Excellence, United Kingdom, recommend that clinicians screen for major depression in persons who have chronic medical conditions with impaired function, as well as persons with a past history of major depression, by asking if low mood, hopelessness and anhedonia are also present.( 12) There are many good recommendations that advocate screening for major depression. Major depression is a chronic illness of considerable morbidity, with high rates of relapse and recurrence ( 4, 5) however, many patients suffering from major depression do not seek help early.( 2, 6) This could be due to various factors: lack of insight into their medical condition the stigma associated with the label of mental illness and financial factors.( 6) The SMHS found that the median time between the onset of illness and help-seeking was five years.( 2) Hence, viewing screening as the first step, followed by diagnosis, early treatment and follow-up, was shown to result in better outcomes.( 7, 8)
Screening – particularly in patients at risk Our next articles will cover suicide risk assessment in a depressed patient and outline the basic principles of management and treatment modalities.
#GOROLL PRIMARY CARE MEDICINE TEST QUESTIONS SERIES#
This is the first of a series of articles that illustrates the approach to the management of major depression in primary care. An accurate diagnosis of major depression and its severity is essential for prompt treatment to reduce morbidity and mortality.
Screening can be performed using clinical tools for major depression, such as the Patient Health Questionaire-2, Patient Health Questionaire-9 and Beck Depression Inventory, so that timely treatment can be initiated.
Major depression has a bidirectional relationship with chronic diseases, and a strong association with increased age and coexisting mental illnesses (e.g. It is potentially a chronic illness with considerable morbidity, and a high rate of relapse and recurrence. Major depression is a common condition seen in the primary care setting, often presenting with somatic symptoms.
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