Outpatient Behavioral Health and Primary Care Clinical Pathway for Evaluation and Treatment of Patients at Risk for a Diagnosis of Depression
Negative Depression Screen
Continue with Depression Evaluation if depression is suspected, otherwise continue with routine care
Positive Depression Screen
Complete Depression Evaluation
Negative Depression Evaluation
- Continue routine care
- Monitor for continued symptoms
of depression
Positive Depression Evaluation
Criteria met for Major Depressive Disorder (MDD) or Other Specified Depressive
Criteria met for Major Depressive Disorder (MDD) or Other Specified Depressive
- Concerns for:
Mild Major Depressive Disorder and Other Specified Depressive Disorder
- All of the following:
- 5-7 DSM-5 Symptoms of Major Depressive Disorder
- Minor Functional Impairment in at least one area or mildly distressing symptoms
- No Comorbid Psychiatric diagnoses
- No Suicidal ideation or behavior
- No Psychotic symptoms
- Or Criteria Met for Other Specified Depressive Disorder (Same treatment applies as with Mild Major Depression)
Moderate Major Depressive Disorder
- All of the following:
- 5-7 DSM-5 Symptoms of Major Depressive Disorder
- Moderate Functional Impairment in at least one area or moderately distressing symptoms
- No Psychotic Symptoms
- Can Include:
- Comorbid Psychiatric Diagnoses
- Suicidal Ideation or Behavior
Severe Major Depressive Disorder
- All of the following:
- At least 7 DSM-5 symptoms of Major Depressive Disorder
- Markedly impaired functioning in at least one area or seriously distressing symptoms
- Presence of at least one of the following
- Comorbid Psychiatric Diagnoses
- Suicidal Ideation or Behavior
- Depression congruent psychotic symptoms
- Active Monitoring or
- Supportive Psychotherapy or
- Family Therapy or
- Evidenced-Based Psychotherapy
- Evidence-Based Psychotherapy
- Medication Management
- Adjunctive Family Therapy
- Consider Consultation with Mental Health Specialist (non-mental health specialists)
- Evidence-Based Psychotherapy
- Medication Management
- Adjunctive Family Therapy
- Consult with or Refer to Mental Health Specialist (non-mental health specialists)
- Intensive Outpatient Program
- Partial Hospitalization Program
Continue Course of Treatment and Monitor Response
Treatment of Non-Responders or Resistant Depression
Posted: June 2020
Revised: November 2023
Authors: J. Lewis, PhD; W. Wallace, DO; O. Lawrence, MD; R. Boyd, PhD; M. Greenspan, LCSW; S. Soffer, PhD; C. Law, PharmD
Revised: November 2023
Authors: J. Lewis, PhD; W. Wallace, DO; O. Lawrence, MD; R. Boyd, PhD; M. Greenspan, LCSW; S. Soffer, PhD; C. Law, PharmD
Evidence
- Adolescent Depression Screening in Primary Care: Who is Screened and Who is at Risk?
- The Treatment for Adolescents with Depression Study (TADS): Long-term Effectiveness and Safety Outcomes
- Comparative Efficacy and Acceptability of Psychotherapies for Depression in Children and Adolescents: A Systematic Review of Network Meta-analysis
- Adolescent Depression: Identification and Treatment
- Evidence-Base Update of Psychosocial Treatments for Child and Adolescent Depression
Community Resource
- IOP and Partial Program Resource List
- Pennsylvania Telephonic Psychiatric Consultation Service Program (TiPS)
- PerformCare NJ
- How to Apply for Medical Assistance in PA or NJ