Depression Care Management

Assess for Depression

Red flags:

  • Chief complaint of sleep disturbance, fatigue, appetite or weight change
  • Chronic pain
  • Chronic illness(es)
  • Recent major stress or loss
  • Multiple unexplained symptoms
  • History of depression

If your patient has one or more of these red flags ask the patient these two questions:
* During the past month, have you often been bothered by little interest or pleasure in doing things?
* Have you been feeling down, depressed or hopeless?

If your patient answers yes to one or both of these questions ask the patient to complete the PHQ-9 form.

The PHQ-9 is an easy but powerful tool to assist healthcare professionals in providing evidence-based care to their depressed patients. Many healthcare professionals who suspect depression ask the patient to complete the free-of-charge PHQ-9 during a break and simply hand-score it before resuming the visit. The PHQ-9 score gives healthcare professionals a tentative diagnosis, identifying patients who need to begin active treatment for the condition. The PHQ-9 also gives healthcare professionals a severity score to monitor treatment response over time.

pdf icon Download the PHQ-9 Form

Treatment Recommendations (pdf icon Printable PDF)

Overview of Treatment for Depression

Query patient about preferred treatment (antidepressant medication or behavioral counseling).

If patient prefers antidepressant medication:

  • Select and initiate antidepressant medication
  • Educate patients on the rules of antidepressants (distribute attached handout).

Rules of Antidepressants (pdf icon Printable PDF)

  • Antidepressants donít work suddenly. Benefit comes on slowly, may take a few weeks.
  • Antidepressants only work if you take them everyday.
  • Antidepressants are not addictive.
  • Side effects are usually mild and get better with time.
  • After you feel better, you must continue to take them for at least four months to reduce the risk of depression returning.
  • Call your healthcare professional before discontinuing use.

Overview of Medication for Depression

 

If patient prefers behavioral counseling*

  • Office nurse and patient identify behavioral counseling providers covered under patientís health insurance who are accepting new patients
  • Office nurse instructs patient on making an appointment with behavioral counseling provider.
  • Office nurse healthcare professional calls patient in two weeks to assure patient has completed referral
  • Healthcare provider assesses patient response to behavioral counseling in 12 weeks
  • Healthcare provider suggests adding antidepressant medication to patients who do not report a full response to behavioral counseling in 12 weeks.

*Short-term behavioral counseling has been shown to be just as effective as antidepressant medication in treating mild to moderate cases of depression.