Tools for Physicians

A Quick Guide to Depression Management

1. Depression Specific Evaluation Questions
   Use on initial visit and all follow-up visits (5 minutes)†
   • Inquire about the diagnostic criteria of MDD
     • How is your mood? (Do you feel sad or down? Everyday?)
     • How are you sleeping? (initial, middle, terminal insomnia)
     • How is your energy level?
     • How is your appetite?
     • How is your concentration ability?
     • How are your interests in the things you usually enjoy?
     • How is your self-esteem? Are you feeling guilty?
     • Have you had any suicidal thoughts?
   • Inquire about functioning.
     • Are you able to get things done that you need to do?
     • How are things going at work?
2. Patient Self-Report Tool†
   • Depression Scale
3. Selecting an Antidepressant
   Discuss drug specific side effects with patient before prescribing antidepressant. [See attached chart]
   • Factors influencing choice
     • Presence of specific symptoms
     • Avoid specific side effects
     • Presence of co-morbid disorder
     • Prior failure with medication
     • Prior positive responses
     • Familial positive response
     • Patient expressed interest
4. Best Practice Recommendations
   • Schedule a follow up appointment 7-14 days after initiation of antidepressant medication to evaluate response.
   • Using depression-evaluation tool at each visit to evaluate patient's level of depression. Schedule at least three visits within the first 12 weeks after initiating antidepressant therapy
   • Have self-help teaching material available for your patients.
5. When to Refer
   • Suicidality
   • Psychotic features
   • Unable to function (e.g., TDI)
   • Uncertain of diagnosis
   • Failure of treatment
   • Co-morbid PTSD, substance use disorder
   • Bipolar disorder