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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.

Health Quality Ontario thanks the following individuals for their generous, voluntary contributions of time and expertise to help create this quality standard:

Peter Voore (co-chair)
Medical Director,
Ambulatory Care and Structural Treatments Programs,
Centre for Addiction and Mental Health

Pierre Blier (co-chair)
Department of Psychiatry and Cellular and Molecular Medicine,
The Royal Ottawa Institute of Mental Health Research

Anita Barnes
Neighbourhood Legal Services,
Lived Experience Advisor

Debbie Bauer
Occupational Therapist,
The Resiliency Tutor

Marie-Hélène Chomienne
Family Physician,
Hôpital Montfort,
Professor and Clinical Investigator,
University of Ottawa

Rachel Cooper
Lived Experience Advisor,
Peer Initiatives Manager,
Stella’s Place

Michael Dunn
Director of Research, Education and Quality Improvement,
Canadian Mental Health Association

Sonu Gaind
Chief of Psychiatry/Medical
Director of Mental Health,
Humber River Hospital,
Associate Professor,
University of Toronto

Sonja Grbevski
Vice-President of Clinical Operations,
Hôtel-Dieu Grace Healthcare

Crystal Kaukinen
Nurse Practitioner,
Lakehead Nurse
Practitioner-Led Clinic

Sidney Kennedy
Senior Scientist/Professor,
University Health Network,
University of Toronto,
St. Michael’s Hospital

Paul Kurdyak
Health Outcomes and Performance Evaluation Research Unit,
Centre for Addiction and Mental Health

Kathryn Leferman
Director of Decision Support,
Erie St. Clair Community Care Access Centre

Sandie Leith
Director of Clinical Services,
Canadian Mental Health Association — Sault Ste. Marie Branch

Paul Links
Department of Psychiatry,
St. Joseph’s Health Care,
Western University

Vesna Milinkovic
Community Mental Health Services,
Fred Victor Centre

Pauline Pariser
Lead Physician,
Taddle Creek Family Health Team,
Primary Care Lead,
University Health Network

Chris Perlman
Assistant Professor,
School of Public Health and Health Systems,
University of Waterloo

Alicia Raimundo
Lived Experience Advisor

Raj Rasasingham
Interim Director of Post-Graduate Education,
University of Toronto — Division of Child Psychiatry,
Staff Psychiatrist,
Humber River Hospital

Neil Rector
Psychologist and Senior Research Scientist,
Sunnybrook Health Sciences Centre,
Department of Psychiatry and Psychological Clinical Science,
University of Toronto

Frank Sirotich
Community Support Services,
Canadian Mental Health Association

Andrew Wiens
Division Head,
Geriatric Psychiatry,
The Royal Ottawa Institute of Mental Health Research

Gillian Young
Clinical Manager,
Ambulatory Care and Structured Treatment Program,
Centre for Addiction and Mental Health

Ari Zaretsky
Vice-President of Education and Chief of Psychiatry,
Sunnybrook Health Sciences Centre,
Associate Professor,
University of Toronto

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