U.S. Preventive Services Task Force banner
U.S. Preventive Services Task Force

Screening: Adult Depression

Discussion

Summary of Findings

We found that primary care depression screening programs were likely to be effective when other staff provided part of the depression care, such as assessment and monitoring in coordination with the primary care provider's treatment or when extra efforts were made to enroll patients in specialty mental health treatment. This conclusion is based on 4 newly published trials and 5 trials that were included in the previous review. We found no data that identified harms of depression screening. Harms of screening were not discussed in the previous report. We also found that depression treatment in older adults was effective, which complements the previous reviews finding that depression treatment is effective in general adult populations. Details of these data can be found in the full report of this review (16).

Finally, we examined harms of second-generation antidepressant use in adults, which were not addressed in the previous review. We found that young adults (aged 18 to 29 years) seem to have an increased risk for suicidal behavior (but not suicide deaths), particularly early in the course of treatment. We found no apparent increase or decrease in risk for suicidal behavioral or deaths in middle-aged populations as a result of second-generation antidepressant use. These conclusions are not definitive, however, because suicide deaths were very rare (and therefore power to detect an increased risk was limited) and data on suicidal behavior were not unanimous. Older adults seem to have lower risk for suicidal behavior, although the risk for upper gastrointestinal bleeding is increased and is a particular concern when combined with NSAIDs.

Comparisons With Other Reviews of Depression Screening

In comparison with the 2002 systematic review (62), a 2005 Cochrane review (10), which excluded all studies that included "complex quality improvement/care management" strategies, concluded that screening programs were not effective in improving health outcomes. Our findings both confirm and extend these 2 previous reviews. Consistent with both the USPSTF and Cochrane reviews, the limited evidence we found on screening and feedback without further care supports suggests that this approach is unlikely to have an effect. Our findings show that depression care support programs that include screening can improve depression symptoms and remission in adult populations.

Why Screening Programs Alone May Not Be Effective

It is puzzling, at first glance, why screening and feedback of results alone would not clearly improve depression outcomes, because it is fairly well-established that they do increase recognition of depression (62). Critics of widespread depression screening suggest that the differences between clinically and screen-detected cases could partially explain this discrepancy (63,64). Patients whose depression is undetected in primary care tend to be less impaired and have milder levels of depression than those who are identified without screening (65-68). These patients may not need active treatment or may not respond as well to medication (69).

The greatest barrier to long-term relief from depression is probably insufficient treatment, rather than inadequate identification. In real-world primary care settings, up to 40% to 67% of patients discontinue their antidepressant medication within 3 months, and few receive adequate follow-up (70-72). Thus, efforts to increase appropriate treatment and improve adherence to treatment are likely to provide the greatest effect. Given the burden on the primary care clinician, it is not surprising that the greatest gains are seen in programs in which other staff provides some of the depression care. Considerable research in recent years has focused on treatment approaches that do just this, such as disease management and collaborative care, which are generally effective (11,73-76) and cost-effective (77). There are probably several mechanisms by which these interventions produce benefits; such mechanisms include enhanced treatment adherence through closer monitoring of treatment tolerability and response, treatment adjustments, and psychosocial support.

Age-Related Risks Associated With Second-Generation Antidepressant Use

Two meta-analyses suggested an increased risk for suicidal behavior in younger adults, particularly those with MDD or those receiving paroxetine (34,41), whereas another demonstrates a protective effect of antidepressant treatment of older adults (35). Other studies outside the scope of this review generally confirm a beneficial effect of antidepressants on suicides in older adults (78,79). However, the increased risk for upper gastrointestinal bleeding in older adults is a concern. Concurrent use of NSAIDs, and to a lesser extent low-dose aspirin and other anticoagulants, seemed to further increase bleeding risks. A recently published meta-analysis estimated increased odds of upper gastrointestinal hemorrhage with SSRI use (OR, 2.36 [CI, 1.44 to 3.85]), particularly when NSAIDs were used concurrently (OR, 6.33 [CI, 3.40 to 11.8]) (80). In people aged 50 years or older without other risk factors, but with both SSRI and NSAID use, the number needed to treat to harm was 106. Among postmarketing reports for adults primarily older than 60 years, median time to bleeding was after 25 weeks of SSRI treatment. These findings may have implications for all adults but particularly for vulnerable older adults or those with a history of gastrointestinal bleeding, given the prevalence of use of analgesic medications (over-the-counter as well as prescription) for therapeutic and preventive reasons.

Limitations of the Review and the Literature

This review took a targeted approach that focused on critical key questions and evidence gaps at the time of the last review and limited the evidence reviews for some questions. We limited the evidence for harms of antidepressant treatment to systematic reviews, supplemented by large prospective observational studies to address deficiencies in short-term RCTs. Although this approach was pragmatic (and our consideration of the literature suggested to us that it was generally adequate), it would not have captured rare or emerging serious medical events that were not already well studied or systematically reviewed. Detailed considerations of potential side effect differences were beyond the scope of this report but are considered elsewhere (47,81). Furthermore, studies that probably met the review criteria but would not fundamentally change the review findings were published between the completion of our review and publication of this article. Appendix Table 3 lists these studies, but they were not formally incorporated into this article.

Furthermore, the available evidence base in antidepressant treatments has limitations. Much of the evidence for serious suicide-related harms derives from short-term RCTs conducted for drug development and regulatory approval. This evidence may not be generalizable to primary care because of recruitment of motivated patients, exclusion of patients with the most severe depression or suicidal patients, high withdrawal rates (81), and sponsorship by the drug industry (which has been shown to be more likely to demonstrate positive effects than independent studies) (82). Also, high placebo effects are documented and may be due to several factors, including the trend toward less severely depressed patients in more recent clinical trials and the ameliorating effect on depression stemming from the support of being in a trial (83).

Conclusion

Good evidence supports the health benefits of programs that combine depression screening and feedback with the support of additional staff to provide some depression care in adults who visit primary care. However, available evidence does not support screening and feedback of results to the clinician in the absence of additional staff that provides some depression care support. The most comprehensive programs included clinician training and treatment protocols provided at the point of care, patient educational materials, office staff training and participation in providing post-visit follow-up, and available mental health referral. Closer monitoring may also be important for reducing uncommon, but potentially serious, adverse events.

Concerns about rare, but very serious, suicide-related antidepressant treatment harms have prompted repeated meta-analyses. The most current evidence on completed suicide does not demonstrate an effect of second generation antidepressants compared with placebo. However, several meta-analyses suggest a true short-term increase in suicidal behavior in young adults (aged 18 to 29 years) who receive antidepressants, particularly those with MDD and those receiving paroxetine. Thus, careful monitoring during early treatment, particularly in younger adults, seems prudent.

Return to Contents

References

1. Hasin DS, Goodwin RD, Stinson FS, Grant BF. Epidemiology of major depressive disorder: results from the National Epidemiologic Survey on Alcoholism and Related Conditions. Arch Gen Psychiatry 2005;62:1097-106. [PMID: 16203955]

2. Kessler RC, Chiu WT, Demler O, Merikangas KR, Walters EE. Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry 2005;62:617-27. [PMID: 15939839]

3. Lyness JM, Caine ED, King DA, Cox C, Yoediono Z. Psychiatric disorders in older primary care patients. J Gen Intern Med 1999;14:249-54. [PMID: 10203638]

4. Schulberg HC, Mulsant B, Schulz R, Rollman BL, Houck PR, Reynolds CF 3rd. Characteristics and course of major depression in older primary care patients. Int J Psychiatry Med 1998;28:421-36. [PMID: 10207741]

5. Kessler RC, Berglund P, Demler O, Jin R, Koretz D, Merikangas KR, et al; National Comorbidity Survey Replication. The epidemiology of major depressive disorder: results from the National Comorbidity Survey Replication (NCSR). JAMA 2003;289:3095-105. [PMID: 12813115]

6. Pincus HA, Tanielian TL, Marcus SC, Olfson M, Zarin DA, Thompson J, et al. Prescribing trends in psychotropic medications: primary care, psychiatry, and other medical specialties. JAMA 1998;279:526-31. [PMID: 9480363]

7. Harman JS, Veazie PJ, Lyness JM. Primary care physician office visits for depression by older Americans. J Gen Intern Med 2006;21:926-30. [PMID: 16918736]

8. Gaynes BN, Rush AJ, Trivedi M, Wisniewski SR, Balasubramani GK, Spencer DC, et al. A direct comparison of presenting characteristics of depressed outpatients from primary vs. specialty care settings: preliminary findings from the STAR*D clinical trial. Gen Hosp Psychiatry 2005;27:87-96. [PMID: 15763119]

9. Gaynes BN, Rush AJ, Trivedi MH, Wisniewski SR, Balasubramani GK, Spencer DC, et al. Major depression symptoms in primary care and psychiatric care settings: a cross-sectional analysis. Ann Fam Med 2007;5:126-34. [PMID: 17389536]

10. Gilbody S, House AO, Sheldon TA. Screening and case finding instruments for depression. Cochrane Database Syst Rev 2005:CD002792. [PMID: 16235301]

11. Gilbody S, Whitty P, Grimshaw J, Thomas R. Educational and organizational interventions to improve the management of depression in primary care: a systematic review. JAMA 2003;289:3145-51. [PMID: 12813120]

12. Coyne JC, Palmer SC, Sullivan PA. Screening for depression in adults [Letter]. Ann Intern Med 2003;138:767. [PMID: 12729435]

13. Hickie IB, Davenport TA, Ricci CS. Screening for depression in general practice and related medical settings. Med J Aust 2002;177 Suppl:S111-6. [PMID: 12358569]

14. Pignone MP, Gaynes BN, Rushton JL, Burchell CM, Orleans CT, Mulrow CD, et al. Screening for depression in adults: a summary of the evidence for the U.S. Preventive Services Task Force. Ann Intern Med 2002;136:765-76. [PMID: 12020146]

15. Harris RP, Helfand M, Woolf SH, Lohr KN, Mulrow CD, Teutsch SM, et al; Methods Work Group, Third US Preventive Services Task Force. Current methods of the US Preventive Services Task Force: a review of the process. Am J Prev Med 2001;20:21-35. [PMID: 11306229]

16. Whitlock EP, O'Connor E, Beil T, Gaynes B. Screening for Depression in Adults and Older Adults in Primary Care: An Updated Systematic Review. 2009. Agency for Healthcare Research and Quality. Accessed at http://www.uspreventiveservicestaskforce.org/uspstf/uspstopics.htm on 24 September 2009.

17. Pirraglia PA, Stafford RS, Singer DE. Trends in prescribing of selective serotonin reuptake inhibitors and other newer antidepressant agents in adult primary care. Prim Care Companion J Clin Psychiatry 2003;5:153-157. [PMID: 15213776]

18. Hansen RA, Gartlehner G, Lohr KN, Gaynes BN, Carey TS. Efficacy and safety of second-generation antidepressants in the treatment of major depressive disorder. Ann Intern Med 2005;143:415-26. [PMID: 16172440]

19. National Institute for Clinical Excellence. Guideline Development Methods: Information for National Collaborating Centres and Guideline Developers. London: NICE; 2004. Accessed at www.nice.org.uk/nicemedia/pdf/CG23fullguideline.pdf on 24 September 2009.

20. Oxman AD, Guyatt GH. Validation of an index of the quality of review articles. J Clin Epidemiol 1991;44:1271-8. [PMID: 1834807]

21. Williams JW Jr, Mulrow CD, Kroenke K, Dhanda R, Badgett RG, Omori D, et al. Case-finding for depression in primary care: a randomized trial. Am J Med 1999;106:36-43. [PMID: 10320115]

22. Rost K, Nutting P, Smith J, Werner J, Duan N. Improving depression outcomes in community primary care practice: a randomized trial of the quEST intervention. Quality Enhancement by Strategic Teaming. J Gen Intern Med 2001;16:143-9. [PMID: 11318908]

23. Wells KB, Sherbourne C, Schoenbaum M, Duan N, Meredith L, Unützer J, et al. Impact of disseminating quality improvement programs for depression in managed primary care: a randomized controlled trial. JAMA 2000;283:212-20. [PMID: 10634337]

24. Whooley MA, Stone B, Soghikian K. Randomized trial of case-finding for depression in elderly primary care patients. J Gen Intern Med 2000;15:293-300. [PMID: 10840264]

25. Callahan CM, Hendrie HC, Dittus RS, Brater DC, Hui SL, Tierney WM. Improving treatment of late life depression in primary care: a randomized clinical trial. J Am Geriatr Soc 1994;42:839-46. [PMID: 8046193]

26. Bergus GR, Hartz AJ, Noyes R Jr, Ward MM, James PA, Vaughn T, et al. The limited effect of screening for depressive symptoms with the PHQ-9 in rural family practices. J Rural Health 2005;21:303-9. [PMID: 16294652]

27. Jarjoura D, Polen A, Baum E, Kropp D, Hetrick S, Rutecki G. Effectiveness of screening and treatment for depression in ambulatory indigent patients. J Gen Intern Med 2004;19:78-84. [PMID: 14748864]

28. Bosmans J, de Bruijne M, van Hout H, van Marwijk H, Beekman A, Bouter L, et al. Cost-effectiveness of a disease management program for major depression in elderly primary care patients. J Gen Intern Med 2006;21:1020-6. [PMID: 16836625]

29. Rubenstein LZ, Alessi CA, Josephson KR, Trinidad Hoyl M, Harker JO, Pietruszka FM. A randomized trial of a screening, case finding, and referral system for older veterans in primary care. J Am Geriatr Soc 2007;55:166-74. [PMID: 17302651]

30. Wells K, Sherbourne C, Schoenbaum M, Ettner S, Duan N, Miranda J, et al. Five-year impact of quality improvement for depression: results of a group-level randomized controlled trial. Arch Gen Psychiatry 2004;61:378-86. [PMID: 15066896]

31. Sherbourne CD, Wells KB, Duan N, Miranda J, Unützer J, Jaycox L, et al. Long-term effectiveness of disseminating quality improvement for depression in primary care. Arch Gen Psychiatry 2001;58:696-703. [PMID: 11448378]

32. Rost K, Nutting PA, Smith J, Werner JJ. Designing and implementing a primary care intervention trial to improve the quality and outcome of care for major depression. Gen Hosp Psychiatry 2000;22:66-77. [PMID: 10822094]

33. Rost K, Nutting P, Smith JL, Elliott CE, Dickinson M. Managing depression as a chronic disease: a randomised trial of ongoing treatment in primary care. BMJ 2002;325:934-7. [PMID: 12399343]

34. Levenson M, Holland C. Statistical evaluation of suicidality in adults treated with antidepressants. In: Laughren TP, ed. Memorandum: overview for December 13 meeting of Psychopharmacologic Drugs Advisory Committee (PDAC). Silver Spring, MD: Center for Drug Evaluation and Research, U.S. Food and Drug Administration; 2006. Accessed at http://www.fda.gov/ohrms/dockets/ac/06/briefing/2006-4272b1-01-FDA.pdf [PDF file, 1 MB; PDF Help] on 29 September 2009.

35. Stone M, Jones ML. Clinical review: relationship between antidepressant drugs and suicidality in adults. In: Laughren TP, ed. Memorandum: overview for December 13 meeting of Psychopharmacologic Drugs Advisory Committee (PDAC). Silver Spring, MD: Center for Drug Evaluation and Research, U.S. Food and Drug Administration; 2006. Accessed at http://www.fda.gov/ohrms/dockets/ac/06/briefing/2006-4272b1-01-FDA.pdf [PDF file, 1 MB; PDF Help] on 29 September 2009.

36. Hammad TA, Laughren TP, Racoosin JA. Suicide rates in short-term randomized controlled trials of newer antidepressants. J Clin Psychopharmacol 2006;26:203-7. [PMID: 16633153]

37. Khan A, Khan S, Kolts R, Brown WA. Suicide rates in clinical trials of SSRIs, other antidepressants, and placebo: analysis of FDA reports. Am J Psychiatry 2003;160:790-2. [PMID: 12668373]

38. Gunnell D, Saperia J, Ashby D. Selective serotonin reuptake inhibitors (SSRIs) and suicide in adults: meta-analysis of drug company data from placebo controlled, randomised controlled trials submitted to the MHRA's safety review. BMJ 2005;330:385. [PMID: 15718537]

39. Saperia J, Ashby D, Gunnell D. Suicidal behaviour and SSRIs: updated meta-analysis [Letter]. BMJ 2006;332:1453. [PMID: 16777898]

40. Committee on Safety of Medicines. Report of the CSM expert working group on the safety of selective serotonin reuptake inhibitor antidepressants. London: Medicines and Healthcare products Regulatory Agency; 2004. Accessed at www.mhra.gov.uk/home/groups/pl-p/documents/drugsafetymessage/con019472.pdf on 29 September 2009

41. Briefing document: paroxetine adult suicidality analysis: major depressive disorder and non-major depressive disorder. GlaxoSmithKline; 2006. Accessed at http://us.gsk.com/docs-pdf/media-news/briefing_doc.pdf on 29 September 2009.

42. Fergusson D, Doucette S, Glass KC, Shapiro S, Healy D, Hebert P, et al. Association between suicide attempts and selective serotonin reuptake inhibitors: systematic review of randomised controlled trials. BMJ 2005;330:396. [PMID: 15718539]

43. Storosum JG, van Zwieten BJ, van den Brink W, Gersons BP, Broekmans AW. Suicide risk in placebo-controlled studies of major depression. Am J Psychiatry 2001;158:1271-5. [PMID: 11481162]

44. Anderson IM. Selective serotonin reuptake inhibitors versus tricyclic antidepressants: a meta-analysis of efficacy and tolerability. J Affect Disord 2000;58: 19-36. [PMID: 10760555]

45. Arroll B, Macgillivray S, Ogston S, Reid I, Sullivan F, Williams B, et al. Efficacy and tolerability of tricyclic antidepressants and SSRIs compared with placebo for treatment of depression in primary care: a meta-analysis. Ann Fam Med 2005;3:449-56. [PMID: 16189062]

46. Beasley CM Jr, Nilsson ME, Koke SC, Gonzales JS. Efficacy, adverse events, and treatment discontinuations in fluoxetine clinical studies of major depression: a meta-analysis of the 20-mg/day dose. J Clin Psychiatry 2000;61:722-8. [PMID: 11078032]

47. Gartlehner G, Hansen RA, Thieda P, DeVeaugh-Geiss A, Gaynes BN, Krebs EE, et al. Comparative Effectiveness of Second-Generation Antidepressants in the Pharmacologic Treatment of Adult Depression. Comparative Effectiveness Review No. 7-EHC007-EF. Rockville, MD: Agency for Healthcare Research and Quality; 2007.

48. MacGillivray S, Arroll B, Hatcher S, Ogston S, Reid I, Sullivan F, et al. Efficacy and tolerability of selective serotonin reuptake inhibitors compared with tricyclic antidepressants in depression treated in primary care: systematic review and meta-analysis. BMJ 2003;326:1014. [PMID: 12742924]

49. Mottram P, Wilson K, Strobl J. Antidepressants for depressed elderly. Cochrane Database Syst Rev 2006:CD003491. [PMID: 16437456]

50. Mulrow CD, Williams JW Jr, Chiquette E, Aguilar C, Hitchcock-Noel P, Lee S, et al. Efficacy of newer medications for treating depression in primary care patients. Am J Med 2000;108:54-64. [PMID: 11059441]

51. Williams JW Jr, Mulrow CD, Chiquette E, Noël PH, Aguilar C, Cornell J. A systematic review of newer pharmacotherapies for depression in adults: evidence report summary. Ann Intern Med 2000;132:743-56. [PMID: 10787370]

52. Jick SS, Dean AD, Jick H. Antidepressants and suicide. BMJ 1995;310: 215-8. [PMID: 7677826]

53. Martinez C, Rietbrock S, Wise L, Ashby D, Chick J, Moseley J, et al. Antidepressant treatment and the risk of fatal and non-fatal self harm in first episode depression: nested case-control study. BMJ 2005;330:389. [PMID: 15718538]

54. Simon GE, Savarino J, Operskalski B, Wang PS. Suicide risk during antidepressant treatment. Am J Psychiatry 2006;163:41-7. [PMID: 16390887]

55. Kroenke K, West SL, Swindle R, Gilsenan A, Eckert GJ, Dolor R, et al. Similar effectiveness of paroxetine, fluoxetine, and sertraline in primary care: a randomized trial. JAMA 2001;286:2947-55. [PMID: 11743835]

56. Rush AJ, Trivedi MH, Wisniewski SR, Nierenberg AA, Stewart JW, Warden D, et al. Acute and longer-term outcomes in depressed outpatients requiring one or several treatment steps: a STAR*D report. Am J Psychiatry 2006;163: 1905-17. [PMID: 17074942]

57. Dalton SO, Sørensen HT, Johansen C. SSRIs and upper gastrointestinal bleeding: what is known and how should it influence prescribing? CNS Drugs 2006;20:143-51. [PMID: 16478289]

58. de Abajo FJ, Rodríguez LA, Montero D. Association between selective serotonin reuptake inhibitors and upper gastrointestinal bleeding: population based case-control study. BMJ 1999;319:1106-9. [PMID: 10531103]

59. van Walraven C, Mamdani MM, Wells PS, Williams JI. Inhibition of serotonin reuptake by antidepressants and upper gastrointestinal bleeding in elderly patients: retrospective cohort study. BMJ 2001;323:655-8. [PMID: 11566827]

60. Dalton SO, Johansen C, Mellemkjaer L, Nørgård B, Sørensen HT, Olsen JH. Use of selective serotonin reuptake inhibitors and risk of upper gastrointestinal tract bleeding: a population-based cohort study. Arch Intern Med 2003; 163:59-64. [PMID: 12523917]

61. Tata LJ, Fortun PJ, Hubbard RB, Smeeth L, Hawkey CJ, Smith CJ, et al. Does concurrent prescription of selective serotonin reuptake inhibitors and nonsteroidal anti-inflammatory drugs substantially increase the risk of upper gastrointestinal bleeding? Aliment Pharmacol Ther 2005;22:175-81. [PMID: 16091054]

62. Pignone MP, Gaynes BN, Rushton JL, Burchell CM, Orleans CT, Mulrow CD, et al. Screening for depression in adults: a summary of the evidence for the U.S. Preventive Services Task Force. Ann Intern Med 2002;136:765-76. [PMID: 12020146]

63. Gilbody S, Sheldon T, Wessely S. Should we screen for depression? BMJ 2006;332:1027-30. [PMID: 16644833]

64. Palmer SC, Coyne JC. Screening for depression in medical care: pitfalls, alternatives, and revised priorities. J Psychosom Res 2003;54:279-87. [PMID: 12670603]

65. Simon GE, VonKorff M. Recognition, management, and outcomes of depression in primary care. Arch Fam Med 1995;4:99-105. [PMID: 7842160]

66. Goldberg D, Privett M, Ustun B, Simon G, Linden M. The effects of detection and treatment on the outcome of major depression in primary care: a naturalistic study in 15 cities. Br J Gen Pract 1998;48:1840-4. [PMID: 10198504]

67. Thompson C, Ostler K, Peveler RC, Baker N, Kinmonth AL. Dimensional perspective on the recognition of depressive symptoms in primary care: The Hampshire Depression Project 3. Br J Psychiatry 2001;179:317-23. [PMID: 11581111]

68. Schwenk TL, Coyne JC, Fechner-Bates S. Differences between detected and undetected patients in primary care and depressed psychiatric patients. Gen Hosp Psychiatry 1996;18:407-15. [PMID: 8937906]

69. Oxman TE, Sengupta A. Treatment of minor depression. Am J Geriatr Psychiatry 2002;10:256-64. [PMID: 11994212]

70. Olfson M, Marcus SC, Tedeschi M, Wan GJ. Continuity of antidepressant treatment for adults with depression in the United States. Am J Psychiatry 2006; 163:101-8. [PMID: 16390896]

71. Simon GE. Evidence review: efficacy and effectiveness of antidepressant treatment in primary care. Gen Hosp Psychiatry 2002;24:213-24. [PMID: 12100832]

72. Solberg LI, Trangle MA, Wineman AP. Follow-up and follow-through of depressed patients in primary care: the critical missing components of quality care. J Am Board Fam Pract 2005;18:520-7. [PMID: 16322414]

73. Badamgarav E, Weingarten SR, Henning JM, Knight K, Hasselblad V, Gano A Jr, et al. Effectiveness of disease management programs in depression: a systematic review. Am J Psychiatry 2003;160:2080-90. [PMID: 14638573]

74. Gensichen J, Beyer M, Muth C, Gerlach FM, Von Korff M, Ormel J. Case management to improve major depression in primary health care: a systematic review. Psychol Med 2006;36:7-14. [PMID: 16356292]

75. Neumeyer-Gromen A, Lampert T, Stark K, Kallischnigg G. Disease management programs for depression: a systematic review and meta-analysis of randomized controlled trials. Med Care 2004;42:1211-21. [PMID: 15550801]

76. Williams JW Jr, Gerrity M, Holsinger T, Dobscha S, Gaynes B, Dietrich A. Systematic review of multifaceted interventions to improve depression care. Gen Hosp Psychiatry 2007;29:91-116. [PMID: 17336659]

77. Wang PS, Simon G, Kessler RC. The economic burden of depression and the cost-effectiveness of treatment. Int J Methods Psychiatr Res 2003;12:22-33. [PMID: 12830307]

78. Juurlink DN, Mamdani MM, Kopp A, Redelmeier DA. The risk of suicide with selective serotonin reuptake inhibitors in the elderly. Am J Psychiatry 2006; 163:813-21. [PMID: 16648321]

79. Barak Y, Olmer A, Aizenberg D. Antidepressants reduce the risk of suicide among elderly depressed patients. Neuropsychopharmacology 2006;31:178-81. [PMID: 16123751]

80. Loke YK, Trivedi AN, Singh S. Meta-analysis: gastrointestinal bleeding due to interaction between selective serotonin uptake inhibitors and non-steroidal anti-inflammatory drugs. Aliment Pharmacol Ther 2008;27:31-40. [PMID: 17919277]

81. National Collaborating Centre for Mental Health. Depression: Management of Depression in Primary and Secondary Care. Clinical Guideline 23. 1-63. London: NICE; 2004.

82. Lexchin J, Bero LA, Djulbegovic B, Clark O. Pharmaceutical industry sponsorship and research outcome and quality: systematic review. BMJ 2003;326: 1167-70. [PMID: 12775614]

83. Ernst CL, Goldberg JF. Antisuicide properties of psychotropic drugs: a critical review. Harv Rev Psychiatry 2004;12:14-41. [PMID: 14965852]

84. Whitlock EP, Lin JS, Chou R, Shekelle P, Robinson KA. Using existing systematic reviews in complex systematic reviews. Ann Intern Med 2008;148: 776-82. [PMID: 18490690]

85. Schreuders B, van Marwijk H, Smit J, Rijmen F, Stalman W, van Oppen P. Primary care patients with mental health problems: outcome of a randomised clinical trial. Br J Gen Pract 2007;57:886-91. [PMID: 17976289]

86. van Marwijk HW, Ader H, de Haan M, Beekman A. Primary care management of major depression in patients aged > or = 55 years: outcome of a randomised clinical trial. Br J Gen Pract 2008;58:680-6, I-II; discussion 687. [PMID: 18826778]

87. Wang PS, Simon GE, Avorn J, Azocar F, Ludman EJ, McCulloch J, et al. Telephone screening, outreach, and care management for depressed workers and impact on clinical and work productivity outcomes: a randomized controlled trial. JAMA 2007;298:1401-11. [PMID: 17895456]

88. Nelson JC, Delucchi K, Schneider LS. Efficacy of second generation antidepressants in late-life depression: a meta-analysis of the evidence. Am J Geriatr Psychiatry 2008;16:558-67. [PMID: 18591576]

89. Pinquart M, Duberstein PR, Lyness JM. Effects of psychotherapy and other behavioral interventions on clinically depressed older adults: a meta-analysis. Aging Ment Health 2007;11:645-57. [PMID: 18074252]

90. Sneed JR, Rutherford BR, Rindskopf D, Lane DT, Sackeim HA, Roose SP. Design makes a difference: a meta-analysis of antidepressant response rates in placebo-controlled versus comparator trials in late-life depression. Am J Geriatr Psychiatry 2008;16:65-73. [PMID: 17998306]

91. Wilson KC, Mottram PG, Vassilas CA. Psychotherapeutic treatments for older depressed people. Cochrane Database Syst Rev 2008:CD004853. [PMID: 18254062]

92. Aursnes I, Gjertsen MK. Common adverse events associated with an SSRI: meta-analysis of early paroxetine data. Pharmacoepidemiol Drug Saf 2008;17: 707-13. [PMID: 18383561]

93. Barbui C, Esposito E, Cipriani A. Selective serotonin reuptake inhibitors and risk of suicide: a systematic review of observational studies. CMAJ 2009;180: 291-7. [PMID: 19188627]

94. Beasley CM Jr, Ball SG, Nilsson ME, Polzer J, Tauscher-Wisniewski S, Plewes J, et al. Fluoxetine and adult suicidality revisited: an updated meta-analysis using expanded data sources from placebo-controlled trials. J Clin Psychopharmacol 2007;27:682-6. [PMID: 18004137]

95. Cipriani A, Geddes JR, Furukawa TA, Barbui C. Metareview on short-term effectiveness and safety of antidepressants for depression: an evidence-based approach to inform clinical practice. Can J Psychiatry 2007;52:553-62. [PMID: 17953159]

96. Cooper-Kazaz R, Lerer B. Efficacy and safety of triiodothyronine supplementation in patients with major depressive disorder treated with specific serotonin reuptake inhibitors. Int J Neuropsychopharmacol 2008;11:685-99. [PMID: 18047754]

97. de Abajo FJ, García-Rodríguez LA. Risk of upper gastrointestinal tract bleeding associated with selective serotonin reuptake inhibitors and venlafaxine therapy: interaction with nonsteroidal anti-inflammatory drugs and effect of acid-suppressing agents. Arch Gen Psychiatry 2008;65:795-803. [PMID: 18606952]

98. Deshauer D, Moher D, Fergusson D, Moher E, Sampson M, Grimshaw J. Selective serotonin reuptake inhibitors for unipolar depression: a systematic review of classic long-term randomized controlled trials. CMAJ 2008;178:1293- 301. [PMID: 18458261]

99. Hansen R, Gaynes B, Thieda P, Gartlehner G, Deveaugh-Geiss A, Krebs E, et al. Meta-analysis of major depressive disorder relapse and recurrence with second-generation antidepressants. Psychiatr Serv 2008;59:1121-30. [PMID: 18832497]

100. Katzman MA, Tricco AC, McIntosh D, Filteau MJ, Bleau P, Chokka PR, et al. Paroxetine versus placebo and other agents for depressive disorders: a systematic review and meta-analysis. J Clin Psychiatry 2007;68:1845-59. [PMID: 18162015]

101. Marcinko D. Antidepressants and suicidality: the basis of controversies. Psychiatr Danub 2007;19:238-40. [PMID: 17914327]

102. Marks DM, Park MH, Ham BJ, Han C, Patkar AA, Masand PS, et al. Paroxetine: safety and tolerability issues. Expert Opin Drug Saf 2008;7:783-94. [PMID: 18983224]

103. Möller HJ, Baldwin DS, Goodwin G, Kasper S, Okasha A, Stein DJ, et al; WPA Section on Pharmacopsychiatry. Do SSRIs or antidepressants in general increase suicidality? WPA Section on Pharmacopsychiatry: consensus statement. Eur Arch Psychiatry Clin Neurosci 2008;258 Suppl 3:3-23. [PMID: 18668279]

104. Papakostas GI, Nelson JC, Kasper S, Möller HJ. A meta-analysis of clinical trials comparing reboxetine, a norepinephrine reuptake inhibitor, with selective serotonin reuptake inhibitors for the treatment of major depressive disorder. Eur Neuropsychopharmacol 2008;18:122-7. [PMID: 17719752]

105. Rahme E, Dasgupta K, Turecki G, Nedjar H, Galbaud du Fort G. Risks of suicide and poisoning among elderly patients prescribed selective serotonin reuptake inhibitors: a retrospective cohort study. J Clin Psychiatry 2008;69:349-57. [PMID: 18278986]

Return to Contents

Copyright and Source Information

This document is in the public domain within the United States.

Requests for linking or to incorporate content in electronic resources should be sent via the USPSTF contact form.

Source: O'Connor EA, Whitlock EP, Beil TL, Gaynes BN. Screening for depression in adult patients in primary care settings: a systematic evidence review. Ann Intern Med 2009;151:793-803.

Return to Contents

AHRQ Publication No. 10-05143-EF-4
Current as of December 2009


Internet Citation:

O'Connor EA, Whitlock EP, Beil TL, Gaynes BN. Screening for Depression in Adult Patients in Primary Care Settings: A Systematic Evidence Review. AHRQ Publication No. 10-05143-EF-4, December 2009. http://www.uspreventiveservicestaskforce.org/uspstf09/adultdepression/addeprart.htm


 


USPSTF Program Office   540 Gaither Road, Rockville, MD 20850