*Care management prioritizes patients in our MSSP and Healthfirst contracts and those patients with Medicaid

Screen patients annually for depression

Screening tests, such as the PHQ-2/9, are not diagnostic but instead identify patients who warrant further investigation. They indicate the severity of depression symptoms within a given time period.

The PHQ-2 is a 2-item screener that asks patients about the frequency of depressed mood and anhedonia over the past two weeks. The PHQ-9 includes 7 additional questions and should be administered in patients who screen positive on the PHQ-2.

Both of these screeners are appropriate for patients 12 and older, however additional screeners exist for special populations.

Visit our Behavioral Health Hub to download screeners in a variety of languages.

The PHQ-2/9 are validated as self-administered measures. When necessary, they can also be administered by clinical staff electronically or via paper copy, prior to coming to the office, while in the waiting room, or during rooming. Follow these best practices when you or your practice staff administer the screening.

There is also evidence that the PHQ-2 can measure treatment outcomes. Therefore, regular screening is helpful in measuring progress over time. 

Evaluate patients who screen positive against the DSM-5 criteria

Patients who screen positive for possible depression should be evaluated against the DSM-5 criteria prior to making a diagnosis of Major Depressive Disorder (MDD). Order basic labs such as TSH and CBC to identify other potential causes of symptoms such as hypo- or hyperthyroidism, anemia, chronic infections, sodium imbalance, and hepatic encephalopathy. 

Psychotherapy may be used in addition to, or in place of, medications in treating depression and anxiety. Referral to psychotherapy is appropriate for patients with mild to moderate symptoms, or where behavioral and attitudinal factors are the main areas of treatment focus.

Mount Sinai Health Partners has implemented the Referral Access Program in a small number of primary care practices to improve connections to behavioral health appointments for therapy and medication management of psychiatric disorders. This program is expected to be scaled across the system over time. 

When referral to psychotherapy is not available, primary care providers may consider implementing some techniques from Cognitive Behavioral Therapy, such as behavioral activation (gradually building motivation and energy through pleasure and mastery) and thought change (identifying and challenging cognitive distortions).



There are many freely available worksheets and resources that you can give to your patients, including several on our Behavioral Health Hub.

SSRIs and SNRIs are the most common antidepressants prescribed in primary care, and can also be effective anxiolytics. Reference our Pharmacology for Anxiety and Depression Management Quick Reference Guide for side-by-side comparisons of the dosages, advantages, approved uses, and side effects of various SSRIs and SNRIs.

As with any medication, it is important to familiarize yourself to the potential risks, including the potential for physiological dependence, clinical worsening, or emergence of suicidal thoughts and behaviors.

Key talking points for conversations with patients

• It may take 4-6 weeks of medication therapy before you start to notice symptom relief and several months before you feel the full effect of the medication

• Once you and your provider find an effective dose, they’ll want to see you on that dose for at least another 4-8 weeks before making any other adjustments



• Antidepressants are not direct mood enhancers but change the serotonin levels in the brain

• SSRIs commonly cause short-term GI side effects and may increase anxiety at first, but these typically resolve after a couple of weeks

• Longer-term side effects may include sexual difficulties and weight gain, but those may be relieved by switching medications, decreasing the dose, and/or adding an additional medication



• Some SSRIs are more prone to cause weight gain than others; if this is a concern let your provider know and they can choose an alternative

• It is important to take your medications every day – missing doses may lead to discontinuation symptoms such as anxiety, irritability, insomnia, and flu-like symptoms



• If you no longer wish to take your medications speak with your provider about how to safely taper

Refer patients to this guide with common questions and concerns about antidepressants.

Find more on the Chronic Condition Management Hub

Mount Sinai Health System's Chronic Condition Management Hub is an online resource center for primary care physicians, specialists, and other care providers with resources and information to help them manage chronic health conditions