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PATIENT HEALTH QUESTIONNAIRE

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Using PHQ-9 Diagnosis and Score for Initial Treatment Selection
A depression diagnosis that warrants treatment or treatment change, needs at least one of the first two questions endorsed as positive (little pleasure, feeling depressed) indicating the symptom has been present more than half the time in the past two weeks.

In addition, the tenth question about difficulty at work or home or getting along with others should be answered at least “somewhat difficult.”

When a depression diagnosis has been made, patient preferences should be considered, especially when choosing between treatment recommendations of antidepressant treatment and psychotherapy.

PHQ-9
Score
Provisional Diagnosis Treatment Recommendation
5-9 Minimal Symptoms* Support, educate to call if worse;
return in 1 month
10-14 Minor depression++
Dysthymia*
Major depression, mild
Support, watchful waiting
Antidepressant or psychotherapy
Antidepressant or psychotherapy
15-19 Major depression, moderately severe Antidepressant or psychotherapy
≥ 20 Major depression, severe Antidepressant and psychotherapy
(especially if not improved on monotherapy)


* If symptoms present ≥ two years, then probable chronic depression which warrants antidepressants or psychotherapy (ask, "In the past 2 years have you felt depressed or sad most days, even if you felt okay sometimes?").

++ If symptoms present ≥ one month or severe functional impairment, consider active treatment.



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