Depression is an illness that involves a person's mood, thoughts and body. It can affect eating, sleeping and general outlook. There is no one way that people look and behave when they have major depression. Appropriate treatment can help most people who suffer from depression. There are many different forms of depression. The measures in this report focus on treatment for adults who have been diagnosed with Major Depressive Disorder, which is also called major depression, clinical depression, or unipolar depression.

About 20-25% of women and 7-12% percent of men will experience depression in their lifetimes. Depression takes a big emotional toll on individuals and families. Despite the high personal and economic impact, not everyone with depression gets the most effective care. For some people, regular conversations with a therapist can help control depression, while others benefit from medication, or need a combination of medication and therapy. Regular exercise is also helpful in treating depression. Many people who have depression do not recognize they are depressed or don't seek treatment. People with depression often have a more difficult time managing other illness such as diabetes, heart disease and asthma.

Depression is the most common cause of disability in the United States, and annually costs U.S. employers an estimated $80 billion in health care costs, absenteeism, and lost productivity.

Patients and Caregivers

• Stay on antidepressant medication at least 12 weeks to allow time for improvement.
• To lower the chances that depression will become a chronic problem for you, stay on the prescribed antidepressants for at least six months.
• Work with your doctor to find the most affordable medications, such as generic drugs.
• Keep follow-up doctor appointments and discuss any problems with medications.
• Talk with your family and friends about your treatment plan so they can provide support.

Doctors and Other Health Care Professionals

Help patients recognize the signs and symptoms of depression.
• Use a patient registry to track care for all of your patients with depression.
• Screen patients for major depression, especially patients who are at high risk or have other chronic illnesses. Talk with your patients about treatment options, including medication and possibly counseling.
• Carefully monitor patients' use of antidepressants and make any necessary adjustments.
• Provide a referral to and coordinate care with a mental health specialist for patients who would benefit from or who prefer counseling or psychotherapy.

Employers and Other Health Care Purchasers

• Provide comprehensive mental health benefits including affordable co-payments for necessary antidepressant medications.
• Ensure that mental health benefits cover access to a network of providers that offer timely appointments.
• Require that your Employee Assistance Program (EAP) include features such as network directories with search and self-referral capabilities and proactive follow-up with employees.
• Help remove the stigma associated with depression by promoting to your employees the availability of the EAP program, communicating the signs of depression, offering confidential depression screening as part of the employee Health Risk Assessment, and encouraging employees to become active participants in the diagnosis and management of depression.

Health Plans

• Eliminate any mental health carve-outs in benefits, and cover the services in ways that are aligned seamlessly with other health care benefits.
• Reimburse providers for administering mental health care in both the primary care setting and the mental health specialty setting.
• Reimburse for a specific procedure code for administering and interpreting a structured depression severity rating scale, such as PHQ-9 or others.
• Allow primary care physicians to directly refer to mental health specialists and promote through reimbursement communication and coordination among providers.
• Assure there is a network of approved mental health providers available to PCPs and members on an area or zip code-specific basis.

Depression Is Real Coalition
National Alliance on Mental Illness
The National Mental Health Association
National Institute of Mental Health
Mayo Clinic depression self assessment
Puget Sound Health Alliance Clinical Improvement Team Report on Depression