U.S. Preventive Services Task Force recommends depression screening for all adults

Ben Schmitt
| Tuesday, Jan. 26, 2016, 11:00 a.m.

Guidelines revealed Tuesday by a leading medical panel recommend for the first time that women should be screened for depression during and immediately after pregnancy.

The U.S. Preventive Services Task Force updated its previous recommendations in two ways: First, family doctors should screen all adults 18 and older. Additionally, the task force specified that women who are pregnant or have recently given birth should be screened for depression by primary care doctors.

“I'm pleasantly surprised,” said Dr. P.V. Nickell, who chairs the psychiatry department at Allegheny Health Network. “I've been practicing for 30 years, and the attention mental health conditions are receiving continue to grow rapidly and appropriately.”

The task force did not include pregnant women in its 2009 suggestions and previously said adults should be screened only if physicians have enough staff to furnish treatment.

Depression is among the leading causes of disability in people 15 years and older, according to the task force, a group of experts who examine health needs on a national basis.

Nickell said clinical depression is the third-largest contributor to missed work days and reduced life expectancy behind cancer and heart disease. Symptoms of depression include: disturbances in appetite and sleep patterns, suicidal thoughts, poor concentration, lethargy and the loss of interest in activities or hobbies once pleasurable.

The task force found evidence that screening during primary care physician visits can help quell depression before symptoms worsen. Treatment can come in the form of talk therapy, antidepressant medication and electroconvulsive therapy.

“Depression is very treatable,” Nickell said. “There's no reason people with symptoms cannot expect a full recovery.”

While another doctor lauded progressive views toward removing all stigmas of depression, he questioned whether the recommendations go far enough.

Dr. Charles F. Reynolds III, UPMC Endowed Professor in Geriatric Psychiatry at the University of Pittsburgh School of Medicine, co-authored an editorial published Tuesday in JAMA Psychiatry entitled “Not Good Enough,” about the screening advice.

“We think it was a great start but still fell way short of the mark,” Reynolds told the Tribune-Review. “Our gripe is the task force tried to make depression screening a one-size-fits-all scenario. Clinical practice is far more varied than that.”

“Ideally, I'd like to see annual screenings and in some cases every six months for people who have recurrent depression,” Reynolds said.

He wrote in JAMA Psychiatry: “This is an important milestone in the journey toward healthy equity, but that journey is long, with miles to go.”

Ann Smith, president of the advocacy group Postpartum Support International, described the focus on pregnant women and new mothers as “fabulous.”

“Postpartum depression can be crippling,” she said. “I had it twice, and I will describe it this way: I felt so bad that if somebody had said, ‘I will cut off your right arm and you will feel better,' I would have put my arm right out there. That is how bad you feel. It is horrible.”

The experiences caused Smith, a nurse/midwife from New York, to become involved with Postpartum Support International, which was founded in 1987 and increases awareness about possible emotional changes that women experience during and after pregnancy.

In addition to the national recommendations, Allegheny Health Network said Tuesday it recently began its own pilot program for pregnant and postpartum women for enhanced depression screening. Women will be screened in selected key visits during and after pregnancies.

“The screening seems like a no-brainer,” said Dr. Pamela Kridgen of Seasons Ob Gyn, which is owned by AHN. “Depression is the elephant that sits in all of the rooms and this is another way of bringing it to people's attention that it can have very significant consequences and it is a very serious disease.”

Ben Schmitt is a Tribune-Review staff writer. Reach him at 412-320-7991 or bschmitt@tribweb.com.

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