The Canadian Task Force on Preventive Health Care releases updated guideline on screening for depression

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CTFPHC says there is a lack of ev­i­dence on the ef­fec­tive­ness of screen­ing in adults with no ap­par­ent symp­toms of de­pres­sion

Ottawa, 13 May, 2013–The Cana­dian Task Force on Pre­ven­tive Health Care (CTFPHC) today re­leased an up­dated guide­line on screen­ing for de­pres­sion in pri­mary care set­tings. Due to a lack of high qual­ity ev­i­dence on the ben­e­fits and harms of screen­ing, the new guide­line rec­om­mends not rou­tinely screen­ing adults who show no ap­par­ent symp­toms of de­pres­sion. The guide­line is pub­lished in the Cana­dian Med­ical As­so­ci­a­tion Jour­nal.

The guide­line up­dates the pre­vi­ous guide­line on screen­ing for de­pression pub­lished by the CTFPHC in 2005, and is based on a com­pre­hen­sive ev­i­dence syn­the­sis and a broad con­sul­ta­tion process that in­cluded 13 key stake­holder or­ga­ni­za­tions. Given the lack of di­rect ev­i­dence avail­able on the ben­e­fits and harms of screen­ing in­di­vid­u­als with no ap­par­ent symp­toms of de­pres­sion, con­cerns re­main about the po­ten­tial harms, in­clud­ing false pos­i­tive di­ag­noses with sub­se­quent un­nec­es­sary treat­ment.

“There is a lack of high qual­ity re­search demon­strat­ing the ben­e­fits and harms of screen­ing in adults with no ap­par­ent symp­toms of de­pres­sion,” said Dr. Michel Jof­fres, mem­ber of the CTFPHC and chair of the de­pres­sion guide­line work­ing group. “With­out ev­i­dence that screen­ing is ben­e­fi­cial for pa­tients with no ap­par­ent symp­toms of de­pres­sion, and con­sid­er­ing the po­ten­tial harms, we rec­om­mend not to rou­tinely screen for de­pres­sion in pri­mary care set­tings—ei­ther in pa­tients at av­er­age risk, or those with char­ac­ter­is­tics that may in­crease their risk for de­pres­sion.”

The cur­rent rec­om­men­da­tion to not rou­tinely screen adults with no ap­par­ent symp­toms of de­pres­sion is a change from the pre­vi­ous CTFPHC rec­om­men­da­tions. The 2005 CTFPHC guide­line rec­om­mended screen­ing adults from the gen­eral pop­u­la­tion in pri­mary care set­tings where in­te­grated staff as­sisted sys­tems were avail­able to man­age treat­ment.

“Given the change in the guide­line, we are rec­om­mend­ing that clin­i­cians be alert to the clin­i­cal symp­toms of de­pres­sion, es­pe­cially in in­di­vid­u­als with char­ac­ter­is­tics that may in­crease their risk for de­pres­sion,” ex­plained Dr. Gabriela Lewin, mem­ber of the CTFPHC work­ing group. “It is im­por­tant to note that these rec­om­men­da­tions do not apply to peo­ple with known de­pres­sion, with past his­tory of de­pres­sion, or peo­ple in treat­ment for de­pres­sion. It is also im­por­tant to note that pa­tients pre­sent­ing with symp­toms or other clues to the pres­ence of de­pres­sion should be ap­pro­pri­ately as­sessed for de­pres­sion.”

The main rec­om­men­da­tions of the Guide­line in­clude:

• Rec­om­men­da­tions on screen­ing for de­pres­sion are pro­vided for adults (18 years of age or older) who pre­sent at a pri­mary care set­ting with no ap­par­ent symp­toms of de­pres­sion. These rec­om­men­da­tions do not apply to peo­ple with known de­pres­sion, with past his­tory of de­pres­sion, or peo­ple in treat­ment for de­pres­sion.
  1. For adults at av­er­age risk for de­pres­sion the CTFPHC rec­om­mends not rou­tinely screen­ing for de­pres­sion (Weak rec­om­men­da­tion; very-low-qual­ity ev­i­dence)
  2. For adults in sub­groups of the pop­u­la­tion who may be at in­creased risk of de­pres­sion the CTFPHC rec­om­mends not rou­tinely screen­ing for de­pres­sion (Weak rec­om­men­da­tion; very-low-qual­ity ev­i­dence)
• The CTFPHC rec­om­mends that high qual­ity ran­dom­ized con­trolled tri­als with un­screened con­trols, eval­u­at­ing the ef­fect of screen­ing for de­pres­sion, be a high pri­or­ity, es­pe­cially in pop­u­la­tions with a higher base­line preva­lence of de­pres­sion. Fu­ture clin­i­cal tri­als should also re­port on the po­ten­tial harms of screen­ing—in­clud­ing false pos­i­tive di­ag­noses with sub­se­quent un­nec­es­sary treat­ment.

For the com­plete re­port and de­tails of the rec­om­men­da­tions, please visit the Screening for Depression Guideline.

About the Cana­dian Task Force on Pre­ven­tive Health Care

The Cana­dian Task Force on Pre­ven­tive Health Care has been es­tab­lished to de­velop clin­i­cal prac­tice guide­lines that sup­port pri­mary care providers in de­liv­er­ing pre­ven­tive health care. The man­date of the ctfphcis to de­velop and dis­sem­i­nate clin­i­cal prac­tice guide­lines for pri­mary and pre­ven­tive care, based on sys­tem­atic analy­sis of sci­en­tific ev­i­dence.