Quality Statement 4: Treatment After Initial Diagnosis

Resources Quality Statements Advisory Committee About

4

Treatment After Initial Diagnosis

People with major depression have timely access to either antidepressant medication or evidence-based psychotherapy, based on their preference. People with severe or persistent depression are offered a combination of both treatments.

Background

Both antidepressant medications and evidence-based psychotherapies (such as cognitive behavioural therapy or interpersonal therapy) can be effective treatments for major depression. Combining antidepressants and psychotherapy may be effective for people with severe or treatment-resistant major depression.

What This Quality Statement Means

For Patients

You should have a choice of psychotherapy or antidepressant drugs. If your depression doesn’t get better, you should be offered a combination of the two treatments.

For Clinicians

Offer people with major depression antidepressants or evidence-based psychotherapy (such as cognitive behavioural therapy or interpersonal psychotherapy). Offer a combination of the two treatments to people with severe or persistent major depression who have tried antidepressants or psychotherapy without an adequate response.

For Health Services

Ensure pharmacotherapy and evidence-based psychotherapies are available and accessible in a timely manner for all people with major depression.

Quality Indicators

Process Indicator

Percentage of people with severe major depression who receive a combination of medications and psychotherapy within 7 days of their assessment

Denominator: total number of people with severe major depression who have been assessed
Numerator: number of people in the denominator who receive medications and psychotherapy within 7 days of their assessment
Data source: local data collection

Percentage of people with mild to moderate major depression who receive medications or psychotherapy within 4 weeks of their assessment

Denominator: total number of people with mild to moderate major depression
Numerator: number of people in the denominator who receive medications or psychotherapy within 4 weeks of their assessment
Data source: local data collection

Structural Indicator

Availability of evidence-based psychotherapy

Data source: local data collection

Definitions Used Within This Quality Statement

Timely access

For severe depression: within 7 days
For mild to moderate depression: within 4 weeks

Evidence-based psychotherapy

This includes cognitive behavioural therapy and interpersonal psychotherapy (see below). Other psychotherapies that may be effective include behavioural activation therapy, short-term dynamic psychotherapy, and mindfulness-based cognitive therapy.

Cognitive behavioural therapy and interpersonal therapy

Cognitive behavioural therapy and interpersonal therapy for major depression should each be:

Delivered on a one-to-one or group basis
Delivered over 16 to 20 sessions over 3 to 4 months
Delivered by an appropriately trained therapist in accordance with a treatment manual

Evidence to Improve Care