Primary care doctors should screen all adults for depression, an expert panel recommended Tuesday.
In its previous recommendation, the U.S. Preventive Services Task Force, which advises the federal government on health, had recommended screening adults for depression only when mental health services were available.
In its new report, the task force said this limitation is no longer needed, because mental health services are more widely available today than in 2009, when its last recommendations were published. Federal law now requires that private insurers cover mental health and physical conditions equally.
"We're hoping that our screening guidelines are an impetus to increase awareness that depression is common, it's painful, it's costly and it's treatable," said Karina Davidson, a member of the task force and a psychologist in the department of psychiatry at New York Presbyterian Hospital/
The task force for the first time said screening benefits specific groups, including older adults, pregnant women and new mothers. In the past, there wasn't strong enough evidence to weigh in on whether depression screening helps or hurts these groups.
Davidson noted depression is often treated with medications, which could pose particular risks for developing fetuses or breastfeeding infants. Although research has found "potential serious fetal harms" from depression medications, the task force concluded that "the likelihood of these serious harms is low."
Newer types of antidepressant medications, such as selective serotonin re-uptake inhibitors, or SSRIs, also have risks, the task force said. SSRIs are associated with an increase in suicidal attempts in adults ages 18 to 29, as well as an increased risk of stomach or intestinal bleeding in adults over than 70.
The task force also singled out a particular type of treatment — called cognitive behavior therapy — that has been shown to help treat depression in pregnant women and new mothers. Cognitive behavioral therapy focuses on changing negative patterns of thought.
Mental health advocates praised the task force's recommendations, published in JAMA, the
Depression also can be life-threatening. More than 41,000 Americans commit suicide each year, according to the
A 2015 study in the Journal of Clinical Psychiatry estimated that depression costs the United States $210 billion a year, with 40% of those costs related directly to depression, and the rest related to indirect costs, such as lost productivity.
"Depression is a major source of disability, so we want to be sure to take every opportunity to get people the help they need," said
Primary care doctors, who treat patients for general needs, are in a good position to screen adults for depression, Snook said. That's because people who suffer from depression may not seek out mental health care.
Doctors can screen for depression by asking patients to fill out short surveys, which often include just 10 questions, Davidson said.
In an accompanying editorial, psychiatrist Michael Thase wrote that primary care providers should screen people with a history of depression at every visit.
People with chronic illnesses, such as diabetes and heart disease, should be screened at least once a year, wrote Thase, a professor of psychiatry at the
Health care providers aren't obligated to follow the task force's advice.
The task force is in the midst of updating its recommendations for depression screening in children and teens. In its last update, published in 2009, the task force said doctors should screen kids ages 12 to 18 for major depressive disorder only if there were services in place to help. At that time, the task force said there wasn't enough evidence to recommend for or against depression screening in younger children.
The task force has been criticized in recent years for saying that most women don't need to get their first mammograms to detect breast cancer until age 50, instead of age 40, the age recommended by groups such as the
In this case, many other groups already recommend screening patients for depression, including the
Screening for depression helps to bring it "out of the shadows," said Ron Honberg, national director of policy and legal affairs at the National Alliance on Mental Illness. "I definitely think mental health has begun to come out of the closet over the past 10 to 20 years. But we stil have a ways to go."