Assessment and Management of Depression

Diagnostic Tools and Severity Classification

The Patient Health Questionnaire (PHQ-9) is a 9-item self-report scale assessing symptoms of major depressive disorder, as defined by the DSM-IV, and can help quantify depression severity 1, 2
The Beck Depression Inventory (BDI) is a 21-item self-report scale with scores ≥20 suggesting clinical depression, and assesses behavioral, cognitive, and somatic components including suicidal ideation 1, 2
The Hamilton Rating Scale for Depression (HAM-D) is a 17-item clinician-administered scale with scores 7-17 suggesting mild depression, 18-24 moderate depression, and ≥25 severe depression 1, 2
The Center for Epidemiological Studies-Depression Scale (CES-D) is a 20-item self-report scale with scores ≥16 suggesting moderate to severe depressive symptomatology 1, 2

The American College of Physicians recommends either cognitive behavioral therapy or second-generation antidepressants (SSRIs, SNRIs, or selective serotonin norepinephrine reuptake inhibitors) after discussing treatment effects, adverse effects, cost, accessibility, and patient preferences 3
Psychotherapy, particularly cognitive-behavioral therapy (CBT), has strong evidence for effectiveness 3, 2
Regular physical activity can help reduce depressive symptoms 1, 2
Psychoeducational therapy provides information about depression and coping strategies 2, 4

Treatment of depression occurs in three phases: acute phase (6-12 weeks), continuation phase (4-9 months), and maintenance phase (≥1 year), with a focus on symptom reduction, preventing relapse, and preventing recurrence 3
Any patient identified as at risk of harm to self or others should be referred for emergency evaluation 1, 2
Medical causes of depressive symptoms, such as unrelieved pain or fatigue, and delirium, should be ruled out 2, 4