Depression screen suggested for all adults

By STEVE MITCHELL, UPI Medical Correspondent  |  May 20, 2002 at 6:05 PM
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WASHINGTON, May 20 (UPI) -- All adults, whether they knowingly have symptoms or not, should be screened for depression by their primary care physician, a panel convened by the federal government recommended Monday.

"The hope is that we would pick up more depression and get it treated," Alfred Berg, chair of the Department of Family Medicine at the University of Washington and chair of the U.S. Preventive Services Task Force, the panel of primary care physicians that developed the recommendations, told United Press International.

"About 10 percent of patients seeing their physicians are depressed and only half of them are recognized," Berg said. "That's a lot of folks, so this has the potential for some major benefits."

The Task Force, commissioned by the Agency for Healthcare Research and Quality, a component of the Department of Health and Human Services, noted in order for the screenings to be beneficial, physicians must ensure patients who screen positive for potential depression receive effective treatment and referrals to proper specialists.

Despite the recommendation for adults, the Task Force found insufficient evidence to justify depression screenings for all adolescents and children. However, it did urge clinicians to be alert for possible signs of depression in younger patients.

"Adolescents may not seem depressed but other things can tip you off that depression may be there," such as school problems and substance abuse problems, Berg said.

Depression accounts for $17 billion in lost workdays each year and many patients may not even realize they suffer from the condition.

"A lot of people may not actually say yes if you ask them if they are depressed," Berg said. "But they may not be sleeping well, they may not be eating well, they may not be interested in normal activities or sex as they normally would."

He added, "You add all this up and the person is depressed."

The disease can also cause seemingly unrelated symptoms, such as gastrointestinal problems or muscle aches and pains, which can cause it to be missed by both patient and doctor, Douglas Jacobs, psychiatrist at Harvard Medical School and founder of National Depression Screening Day, told UPI.

Jacobs said he endorses the recommendations because "screening would lead to early detection of depression, which would increase the likelihood of a positive response to treatment." The majority of people will get better with a combination of psychotherapy and medication, he added.

Another reason depression may be missed is patients are often "reluctant to talk about their emotional symptoms with their doctor," Jacobs said. Screening tests, which usually include questions about a patient's mood or changes in behavior, could help alleviate this and catch missed cases of depression.

The Task Force noted that women, people with a family history of depression, the unemployed and those with chronic disease are most at risk for depression.

Others at risk include those "who have experienced a recent loss, those with a history of alcohol abuse or medication abuse," Jacobs said. Women also may be vulnerable to developing postpartum depression following childbirth, he added.

Symptoms of depression may include "a depressed mood, loss of interest in usual activities, changes in sleep, changes in appetite, lack of energy, difficulty making decisions, feelings of worthlessness, and thoughts of suicide." Jacobs said.

The recommendations appear in Tuesday's edition of the Annals of Internal Medicine.

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