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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.

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.


Monitoring and assessing treatment response is critical to optimizing treatment with antidepressant medication. If inadequate response to medication is noted, it is imperative that the health care provider explain and offer other treatment options. For some specific subpopulations, different time frames may be more appropriate; for example, the elderly may require up to 12 weeks to respond.

For Patients

If you start on a new antidepressant, your health care professional should closely monitor the therapeutic effects or side effects of the medication. If your dosage is adjusted or your medications switched, and you’re still not feeling better, another therapy should be tried.


For Clinicians

Assess patients for 2 weeks after they start a new antidepressant to determine their response. If needed, adjust the dosage or switch medications at this time. Complete an additional assessment every 2 weeks up to 6 to 8 weeks. If they do not respond, offer a different antidepressant, psychotherapy, or both.


For Health Services

Ensure the availability of and access to appropriate pharmacotherapy and psychotherapy for people suffering from major depression.

Process Indicator

Percentage of people with major depression who receive antidepressant medication who are monitored for 2 weeks for the onset of effects

  • Denominator: total number of people with major depression who receive antidepressant medication
  • Numerator: number of people in the denominator who are monitored for the onset of effects for 2 weeks after starting the medication
  • Data source: local data collection

Percentage of people with major depression who do not respond to their antidepressant medication within 8 weeks who are offered another or additional antidepressant or psychotherapy

  • Denominator: total number of people with major depression receiving antidepressant medication who have not responded to the medication by 8 weeks of treatment
  • Numerator: number of people in the denominator who are offered another or additional antidepressant or psychotherapy
  • Data source: local data collection
Onset of effects

This is indicated by an improvement in symptoms of at least 20%. This improvement is determined using the same scale used in the initial assessment.


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.

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