Melissa Healy
Los Angeles Times

In a sign that the treatment of depression is shifting to the mainstream of American medical care, a federal panel has recommended that general physicians screen all adults for depression and treat those affected by the mood disorder with antidepressant medication, refer them to psychotherapy or do both.

For the first time, the U.S. Preventive Services Task Force also advised that physicians assess all pregnant and postpartum women for signs of depression, as well as elderly adults.

The task force, which assesses the harms and benefits of screening programs and makes recommendations accordingly, said that screening pregnant and postpartum women for depression would have a “moderate net benefit.”

At the same time, the panel acknowledged that, given the small risk that treatment with antidepressants could harm a developing fetus, pregnant women with depression should be offered a “range of treatment options,” including cognitive behavioral therapy, which has been found effective in relieving depressive symptoms.

As many as 1 in 5 women who give birth each year is thought to have postpartum depression symptoms. The new recommendations, published Tuesday in the Journal of the American Medical Association, ensure that virtually all adults consulting with a physician will at some point be asked a battery of questions aimed at discerning the signs of depression. Among those are prolonged sadness or irritability, feelings of guilt and worthlessness, disturbances of sleep or appetite, and loss of energy and interest in activities once a source of enjoyment.

“What this recommendation is saying is that, as a country, we don’t have an excuse” for failing to diagnose and treat depression, said University of California, Los Angeles, psychiatrist Dr. Nelson Freimer, director of a university initiative that aims to improve depression care and find the disorder’s biological links.

“This is one of the nation’s leading killers and causes of disability, and it has enormous effects throughout our society,” Freimer said.