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March 2016

Implementing Recommendations for Depression Screening of Adults: How Can Neurology Contribute to the Dialogue?

Author Affiliations
  • 1Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia
  • 2Department of Neurology, Emory University School of Medicine, Atlanta, Georgia
  • 3Department of Radiology, Emory University School of Medicine, Atlanta, Georgia
JAMA Neurol. 2016;73(3):270-271. doi:10.1001/jamaneurol.2015.5048

The US Preventive Services Task Force (USPSTF) has offered its updated recommendations for the screening for depression in adults. The document, published this week in JAMA,1 updates a 2009 review of the evidence as to the net benefit of accurate diagnosis, effective treatment, and appropriate follow-up after depression screening for adults older than 18 years, including pregnant and postpartum women, complementing previous recommendations for depression screening in children and adolescents (http://www.uspreventiveservicetaskforce.org). There is no question that primary care screening offers a first-line medical opportunity to identify patients with an undiagnosed major depressive episode. Use of standardized screening instruments and evidence-based treatments are a critical first step. That said, an unsettling reality remains: how, even with improved efficiency of screening and more timely diagnoses, do we secure the necessary resources to ensure that depressed patients not only receive treatment and follow-up, but that the treatment selected is both appropriate and optimized for the individual. Compounding these challenges, neurological patients with depression, even when identified, may be reticent to accept psychiatric treatment,2 and like internal medicine and primary care, the time and resources needed to address the behavioral “symptoms” are often eclipsed by core demands of the principal neurological or medical condition.

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