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Am Fam Physician. 2023;107(3):323-325

This clinical content conforms to AAFP criteria for CME.

Author disclosure: No relevant financial relationships.

Key Points for Practice

• In uncomplicated major depression, combining medications and psychotherapy is not more effective than monotherapy.

• For severe, persistent, or recurrent major depression, combining medications and psychotherapy is more effective than monotherapy.

• Continuing medications for at least six months after symptom remission will reduce relapse by nearly one-third.

• When patients with symptom remission are at high risk of relapse, cognitive behavior therapy, interpersonal therapy, or mindfulness-based cognitive therapy can reduce relapse risk.

From the AFP Editors

One in five people in the United States is diagnosed with major depression during their lifetime, and one in 10 copes with depression in any given year. Women have twice the risk of depression as men. Risk is higher in younger adults, people with lower incomes, and White and Native American ethnicities. The U.S. Department of Veterans Affairs and U.S. Department of Defense (VA/DoD) published guidelines on the management of major depressive disorder.

Screening for Depression

The U.S. Preventive Services Task Force recommends screening all patients for depression. The two-question Patient Health Questionnaire (PHQ-2) can be used, and if positive the longer PHQ-9 can be used for follow-up. These questionnaires are recommended for older adults because of similar sensitivity to geriatric-specific screening tools. Although the Edinburgh Postnatal Depression Scale is commonly used for pregnant and postpartum patients, the PHQ-2 is also effective for this population.

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Coverage of guidelines from other organizations does not imply endorsement by AFP or the AAFP.

This series is coordinated by Michael J. Arnold, MD, Assistant Medical Editor.

A collection of Practice Guidelines published in AFP is available at

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