Depresion medicina

U.S. Preventive Services Task Force
Screening for Depression in Adults:   Recommendation Statement
See related Putting Prevention into Practice on page 985. See related editorial on page 891. This summary is one in a series excerpted from the Recommendation Statements released by the U.S. Preventive Services Task Force (USPSTF). These statements address preventive health services for use inprimary care clinical settings, including screening tests, counseling, and preventive medications. ▲

Summary of Recommendations   and Evidence The U.S. Preventive Services Task Force (USPSTF) recommends screening adults for depression when staff-assisted depression care supports are in place to assure accurate diagnosis, effective treatment, and follow-up (Table 1). B recommendation.The USPTF recommends against routinely screening adults for depression when staff-assisted depression care supports are not in place. There may be considerations that support screening for depression in an individual patient. C recommendation. Rationale Importance. Depression is among the leading causes of disability in persons 15 years or older. It affectsindividuals, families, businesses, and society. It is common in primary care patients. Detection. The USPSTF found good evidence that screening improves the accurate identification of patients with depression in primary care settings. Benefits of detection and early intervention. The USPSTF found good evidence that treatment with antidepressants, psychotherapy, or both decreases clinical morbidity in adultsand older adults with depression identified through screening in primary care settings. The USPSTF found good evidence that programs combining depression screening and feedback with staff-assisted depression care supports improve clinical outcomes in adults and older adults. The USPSTF found fair evidence that screening and feedback alone without staffassisted care supports does not improveclinical outcomes in adults and older adults. Harms of detection and early intervention. The USPSTF found no evidence of harms of screening for depression in adults or older adults.

This clinical content conforms to AAFP criteria for evidence-based continuing medical education (EB CME). See CME Quiz on page 887. A collection of USPSTF recommendation statements reprinted in AFP is available athttp://www. aafp.org/afp/uspstf. The complete version of this statement, including supporting scientific evidence, evidence tables, grading system, members of the USPSTF at the time this recommendation was finalized, and references, is available on the USPSTF Web site at http://www. uspreventiveservices taskforce.org/uspstf/ uspsaddepr.htm.

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The USPSTF found at least fair-quality evidence that second-generation antidepressants (mostly selective serotonin reuptake inhibitors [SSRIs]) increase suicidal behaviors in adults 18 to 29 years of age, especiallythose with major depressive disorder and those who receive paroxetine. The USPSTF found at least fair-quality evidence that SSRI use is associated with an increased risk of upper gastrointestinal bleeding in adults older than 70 years, and the risk increases with age. USPSTF assessment. The USPSTF concludes that for adults who receive care in clinical practices that have staff-assisted depressioncare supports in place, there is at least moderate certainty that the net benefit of screening for depression is at least moderate. The USPSTF concludes that for adults who receive care in clinical practices without staffassisted depression care supports in place, there is at least moderate certainty that the net benefit of screening for depression is small. Clinical Considerations Patient...