Suggested Screening Looks for Depression

PHILADELPHIA —  Asking all patients who walk into offices for tests, physicals and appointments two simple questions about whether they have experienced some of the warning signs of depression can swiftly begin to identify 90% of people who suffer from major depression, health experts say.

The U.S. Preventive Services Task Force, a highly influential group of scientists that sets widely followed standards on topics ranging from prostate cancer screenings to mammograms, recommended last month that doctors routinely begin screening all patients for depression. America’s primary-care doctors are missing and mistreating more than half of all cases of the common mental disorder, the independent panel said.

The recommendation is the latest manifestation of the growing recognition that depression is one of the most common--and most commonly undiagnosed and untreated--chronic illnesses. About 19 million American adults suffer from depression, and estimates suggest that as many as two-thirds do not get treatment. The new recommendations could drastically recruit many of these people into treatment, and add millions to the numbers who are already taking antidepressants such as Prozac.

Two-thirds of patients with depression are treated in primary-care settings. Primary-care doctors also see most patients whose depression goes undiagnosed, as people come through clinics for routine outpatient care.

“Primary-care doctors have done only a modestly good job in recognizing and treating depression,” said Michael Pignone, a University of North Carolina researcher who analyzed the issue for the task force. “Only half of cases are recognized in primary settings and less than that are properly treated.”

The task force did not find sufficient evidence to recommend routine depression screening for children and adolescents.

Two questions ought to become the basic repertoire of every patient visit, the task force recommended, in an announcement that coincided with the American Psychiatric Assn.’s annual meeting here: “Over the past two weeks, have you felt down, depressed, or hopeless?” and “Over the past two weeks, have you felt little interest or pleasure in doing things?”

If a patient answers yes to either question, the task force recommended that doctors offer patients written or oral questionnaires. These ask more specific questions and establish whether the problems are transient or persistent.

“Most patients who are depressed have some diminished function,” said Alfred Berg, a professor at the University of Washington in Seattle and the chair of the task force. “They don’t take pleasure in activities, they are not productive, can’t concentrate, are often sleep-deprived, don’t eat well, have headaches or low back pain. If you go through a formal assessment, you find the depressed patients aren’t doing as well.”