Symptom Severity and Guideline-Based Treatment Recommendations for Depressed Patients: Implications of DSM-5’s Potential Recommendation of the PHQ-9 as the Measure of Choice for Depression Severity

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The National Institute for Health and Clinical Excellence (NICE) and the recently revised American Psychiatric Association (APA) guidelines for the treatment of depression both indicate that the severity of depression should be considered when initiating treatment. The NICE guidelines recommended psychotherapy as the first treatment option for mildly depressed patients. The APA treatment guidelines recommended either psychotherapy and pharmacotherapy as monotherapies for depression of mild or moderate severity, and pharmacotherapy (with or without psychotherapy) for severely depressed patients. If the severity of depression is to influence treatment choice in clinical practice, it is important to have available clinically useful, reliable and valid methods of distinguishing between levels of depression severity.

Many scales have been developed to measure the severity of depression. One of the most frequently used self-administered measures is the 9-item Patient Health Questionnaire (PHQ-9). In describing the initial development of the PHQ-9, Kroenke et al. recommended cutoff scores corresponding to mild, moderate, moderately severe and severe levels of depression severity, and the validity of these cutoffs was supported by demonstrating differences in health-related quality of life between adjacent severity categories.

Symptom Severity and Guideline-Based Treatment Recommendations for Depressed Patients: Implications of DSM-5’s Potential Recommendation of the PHQ-9 as the Measure of Choice for Depression Severity

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