Experts believe that 7 percent of Americans deal with depression each year, but many people with depression do not receive treatment.
That’s unfortunate, because treatment for depression can be effective. If you’re depressed, getting help can improve your quality of life.
A major depressive episode is defined as a period of at least two weeks when a person experiences a depressed mood or loss of interest or pleasure in daily activities and has multiple symptoms such as problems with sleep, eating, energy, concentration or self-worth. Depression can seriously interfere with your ability to function at work or at school or to take care of yourself or others.
Depression is usually treated with talk therapy, medication or both.
Why do so many get no treatment? For many people, the reason might simply be that they have never been screened for depression, says Dana M. Neutze, MD, PhD, associate medical director of the UNC Family Medicine Center at Chapel Hill.
For more than a decade, the U.S. Preventive Services Task Force has recommended screening for depression for all adults if there are resources available to correctly diagnose and manage the depression. In 2016, this recommendation was updated to clearly include pregnant and postpartum women. But there are still a lot of people who don’t get screened.
What Is Depression Screening?
A depression screening is typically a survey or series of questions that a doctor or another healthcare provider goes through to determine if you have depression. The provider may ask about your feelings, mood, sleep habits and other symptoms:
- How long have you been feeling depressed?
- Are you sleeping more than usual or having trouble sleeping?
- Have you lost or gained weight?
- Are you having trouble concentrating or making decisions?
- Have you had any thoughts about harming yourself?
The provider may also give you a physical exam or order a blood test to find out if you have a medical condition, such as anemia or thyroid disease, that might cause you to feel depressed.
How Does Depression Screening Work?
Adults are typically screened for depression using a standardized form called the Patient Health Questionnaire-2, or PHQ-2, as a first step.
“This is a two-question form that asks the patient how often, over the last two weeks, they have had little interest or pleasure in doing things or felt down, depressed or hopeless,” Dr. Neutze says. “We give that form to every patient 18 years old or older once a year.”
The patient’s answers result in a PHQ-2 score from 0 to 6. If the patient scores 3 or greater on the PHQ-2, then the patient is asked to fill out a longer questionnaire, called the PHQ-9, to get more information about symptoms. The PHQ-9 includes the same questions that are on the PHQ-2 but adds seven more, including one asking if the patient has had thoughts about self-harm.
“The doctor needs to use a bit of judgment in interpreting these scores,” Dr. Neutze says. “For example, if the patient recently had a death in the family or has just returned from a long trip and was really tired for that reason, that needs to be taken into account.”
A PHQ-9 score of 0-4 is considered either no depression or minimal depression, 5-9 is mild depression, 10-14 is moderate depression and 15-19 is moderately severe depression. A score of 20-27 is considered to be severe depression; the doctor will typically prescribe medication and give an expedited referral to a mental health specialist for psychotherapy.
Once a patient has been diagnosed with depression, his or her primary care provider can begin treatment right away, Dr. Neutze says. A mental health care provider can provide additional support as needed.
Feeling Depressed? Here’s What You Can Do
If you think you may be depressed, tell your primary care provider. You may be able to begin this conversation by phone or electronically.
In addition to talking with your doctor, there are mental health apps that can help.
The National Institute of Mental Health website provides resources for people with depression, including information on treatment and practical steps you can take right away to feel better.
The most important thing you can do if you’re feeling depressed is to start talking about it with people you trust, one of whom should be your doctor.
A primary care provider can screen you for depression and also begin mental health treatment if needed. Find a primary care provider near you.