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Evidence to Improve Care

Major of Depression

Care for Adults and Adolescents

Click below to see a list of brief quality statements and scroll down for more information.


Quality standards are sets of concise statements designed to help health care professionals easily and quickly know what care to provide, based on the best evidence.

See below for the quality statements and click for more detail.


Quality Statement 1: Comprehensive Assessment
People suspected to have major depression have timely access to a comprehensive assessment.


Quality Statement 2: Suicide Risk Assessment and Intervention
People with major depression who are at considerable risk to themselves or others, or who show psychotic symptoms, receive immediate access to suicide risk assessment and preventive intervention.


Quality Statement 3: Shared Decision-Making
People with major depression jointly decide with clinicians on the most appropriate treatment for them, based on their values, preferences, and goals for recovery. They have access to a decision aid in a language they understand that provides information on the expected treatment effects, side effects, risks, costs, and anticipated waiting times for treatment options.


Quality Statement 4: Treatment After Initial Diagnosis
People with major depression have timely access to either antidepressant medication or evidence-based psychotherapy, based on their preference. People with severe or persistent depression are offered a combination of both treatments.


Quality Statement 5: Adjunct Therapies and Self-Management
People with major depression are advised about adjunctive therapies and self-management strategies that can complement antidepressant medication or psychotherapy


Quality Statement 6: Monitoring for Treatment Adherence and Response
People with major depression are monitored for the onset of, or an increase in, suicidal thinking following initiation of any treatment. People with major depression have a follow-up appointment with their health care provider at least every 2 weeks for at least 6 weeks or until treatment adherence and response have been achieved. After this, they have a follow-up appointment at least every 4 weeks until they enter remission.


Quality Statement 7: Optimizing, Switching, or Adding Therapies
People with major depression who are prescribed antidepressant medication are monitored for 2 weeks for the onset of effects; after this time, dosage adjustment or switching medications may be considered. People with major depression who do not respond to their antidepressant medication after 8 weeks are offered a different or additional antidepressant, psychotherapy, or a combination of antidepressants and psychotherapy.


Quality Statement 8: Continuation of Antidepressant Medication
People taking antidepressant medication who enter into remission from their first episode of major depression are advised to continue their medication for at least 6 months after remission. People with recurrent episodes of major depression who are taking antidepressant medication and enter into remission are advised to continue their medication for at least 2 years after remission.


Quality Statement 9: Electroconvulsive Therapy
People with severe or treatment-resistant major depression have access to electroconvulsive therapy.


Quality Statement 10: Assessment and Treatment for Recurrent Episodes
People with major depression who have reached full remission but are experiencing symptoms of relapse have timely access to reassessment and treatment.


Quality Statement 11: Education and Support
People with major depression and their families and caregivers are offered education on major depression and information regarding community supports and crisis services.


Quality Statement 12: Transitions in Care
People with major depression who transition from one care provider to another have a documented care plan that is made available to them and their receiving provider within 7 days of the transition, with a specific timeline for follow-up. People with major depression who are discharged from acute care have a scheduled follow-up appointment with a health care provider within 7 days.

6

Monitoring for Treatment Adherence and Response

People with major depression are monitored for the onset of, or an increase in, suicidal thinking following initiation of any treatment. People with major depression have a follow-up appointment with their health care provider at least every 2 weeks for at least 6 weeks or until treatment adherence and response have been achieved. After this, they have a follow-up appointment at least every 4 weeks until they enter remission.


Assessing treatment response is critical to optimizing care. Nonadherence to treatment is common and a major reason for inadequate response to treatment and the recurrence of symptoms. As depression is increasingly conceptualized and treated as a recurrent or chronic condition, efforts to enhance treatment adherence should be encouraged. Additional emphasis should be put on closely monitoring adolescents and young adults (under 25 years of age).

For Patients

Your health care professional should monitor you closely.


For Clinicians

Follow up at least every 2 weeks with people taking antidepressants, for at least 6 weeks or until treatment adherence and response are achieved. Then, follow up every 4 weeks until remission. Provide information on the importance of being consistent and continuing treatment despite improvement or side effects.

Note: People with significant risk factors such as psychotic symptoms and significant side effects from medications must be followed up more frequently or for a longer duration, according to your discretion.


For Health Services

Facilitate the ability of providers to schedule follow-up appointments at regular intervals, and ensure providers are available to actively monitor adolescents and young adults newly started on antidepressant medications.

Process Indicator

Percentage of people with major depression taking antidepressants who are monitored for an onset of, or increase in, suicidal ideation for at least 6 weeks following the initiation of medication

  • Denominator: total number of people with major depression taking antidepressant medication
  • Numerator: number of people in the denominator who are monitored for an onset of, or increase in, suicidal ideation for at least 6 weeks following the initiation of antidepressant medication
  • Data source: local data collection
Response

This is indicated by an improvement in symptoms of at least 50%. This improvement is determined using the same scale used in the initial assessment.


Remission

This is defined as a score below the predetermined threshold on the depression symptom rating scale used at the initial assessment and follow-up.

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