Government panel urges depression screening--for everyone

Depression can rob its victims of happiness, play havoc with relationships, ruin job productivity, and turn a new mom’s joy into despair. Up to 26 percent of women and 12 percent of men will have depression at some point in their lives. As many as 1 in 5 women experience depression during pregnancy or shortly after the birth of their baby.

Last month, the U. S. Preventive Services Task Force issued a recommendation that primary care physicians should make depression screening a routine part of patient care for every adult and adolescent over the age of 12. The task force cautioned that adequate systems to diagnose and treat depression should also be in place.

Many mental health experts applaud the recommendations.

“This is one of the nation’s leading killers and causes of disability, and it has enormous effects throughout our society. It’s just too important to be optional,” Nelson Freimer, a University of California, Los Angeles, psychiatrist told the Los Angeles Times.

But others don’t believe across-the-board screening is the right way to fight depression. Some even see it as dangerous. Even the task force noted there is, “moderate certainty that screening for depression in general adults is of moderate net benefit”—hardly a resounding endorsement that justifies the potential risks of routine screening, several experts said.

One of the main risks of widespread screening is that perfectly healthy people who are not depressed could end up with a diagnosis anyway.

An analysis of depression screening published in the Canadian Medical Association Journal in 2012 found that in primary care settings more than 80 percent of positive screening results are likely false-positives.

Although in theory the object of screening is simply to identify patients who need further assessment, in practice it often doesn’t work that way. In a mental health system that is stretched beyond capacity, with psychiatrists booked out for months, diagnosis and treatment of mental illness often falls to primary care physicians.

“Primary care doctors prescribe 80 percent of the antidepressants in the United States, sometimes after a seven minute visit,” Allen Frances, professor of psychiatry and behavioral sciences at Duke University, told Health News Review.

Frances pointed out that the United States already has extremely high rates of antidepressant use and warned the screening guidelines will only increase that, putting more patients at risk of adverse side effects.

“Instead of screening all adults and adolescents for depression, efforts would be better spent helping those with true clinical depression,” Frances told online news site STAT. “It doesn’t make sense to create an army of fake ‘patients’ when hundreds of thousands of Americans with serious depression and other mental health issues slip through wide cracks in our broken healthcare system and receive minimal or no treatment.”

Others fear widespread screening will place a financial burden on an already struggling medical system. The task force gave its recommendation a “B” rating, which means depression screening must be covered under the Affordable Care Act. Private health plans would have to provide coverage with no cost-sharing such as copayments, deductibles, or co-insurance, according to the U.S. Department of Labor. Although the government can’t make primary care doctors conduct the screenings, physicians often follow recommendations like this, making them a de facto healthcare norm.

“Despite how much we wish screening and early intervention would help people at risk of a mental health crisis, screening for depression is not supported by good science, unlikely to reduce the burden of mental illness in the overall population, and always includes a likelihood of causing harm,” Alan Cassels, a drug policy researcher at the University of Victoria, wrote in Health News Review.