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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.

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


Therapies and self-management strategies such as light therapy, yoga, physical activity, behavioural activation, sleep hygiene, and good nutrition can be effective complements to antidepressant medication or psychotherapy for major depression, potentially resulting in faster improvement and fewer residual symptoms. Therapies that are more feasible and pleasurable for people improve their likelihood of being effective.

For Patients

In addition to medication and psychotherapy, your health care professional should offer you educational materials about other steps you can take that might improve your depression, such as light therapy, yoga, and exercise.


For Clinicians

Advise people with major depression about adjunct therapies and self-management strategies that can complement antidepressant medication or psychotherapy. These include light therapy, yoga, physical therapy, sleep hygiene, and nutrition.


For Health Services

Ensure the availability of relevant education materials about adjunct therapies and self-management strategies for major depression.

Process Indicator

Percentage of people with major depression who receive information about adjunct therapies and self-management strategies

  • Denominator: total number of people with major depression
  • Numerator: number of people in the denominator who receive information about adjunct therapies and self-management techniques
  • Data source: local data collection
Adjunct therapies

These include light therapy, yoga, and physical activity.

  • Light therapy: This therapy involves daily exposure to bright light, usually administered at home with a fluorescent light box. The standard “dosage” of light is 10,000 lux (intensity) for 30 minutes per day, given early in the morning
  • Yoga: This is a discipline that integrates physical postures, breath control, and meditation. The duration should be at least 4 weeks, with an average frequency of 4 sessions a week, and 45 to 60 minutes per session
  • Physical activity: Physical activity of any sort administered for at least 8 weeks, usually 3 times a week for 30 to 60 minutes per session

Self-management strategies

These include sleep hygiene and nutrition.

  • Sleep hygiene: The habits and practices of maintaining a regular sleep schedule; avoiding excess eating, drinking, or smoking before going to sleep; and establishing a proper sleep environment
  • Nutrition: Maintaining a healthy, balanced diet and correcting any nutritional deficiencies

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