Ask patients whether they have experienced depressed mood and anhedonia during the last month using the two-question model (PHQ-2):
“Over the past 2 weeks, have you felt down, depressed, hopeless?”
“Over the past 2 weeks, have you felt little interest or pleasure in doing things?”
Consider using the 4 “SALSA” questions to assess for the presence of four symptoms of depression: sleep disturbance, anhedonia, low self-esteem, and change in appetite in patients with a positive PHQ-2. Two of the four symptoms can confirm depression.
Use additional instruments such as the PHQ-9 in patients with symptoms.
Recognize the elderly as a high-risk group for depression and screen them appropriately, generally using the Geriatric Depression Scale.
Assess the severity of depression and functional impairment using the PHQ-9.
Assess suicidal ideation, intent, and risk.
Consider screening for hypothyroidism in patients with depression; base other laboratory testing for secondary causes of depression on clinical evaluation.
Recognize that the syndrome of major depression can be a presenting feature of other major mental disorders and substance abuse.