American Medical Directors Association


Depression is a spectrum of mood disorders characterized by a sustained disturbance in emotional, cognitive, behavioral, or somatic regulation and associated with significant functional impairment and a reduction in the capacity for pleasure and enjoyment. It is common among patients in the long-term care setting and can have a major effect on their quality of life. Depression may seriously impede the achievement of the highest practicable level of well-being for many patients in the long-term care setting. Early recognition and diagnosis, along with careful, caring treatment, offers long-term care patients with depression a better quality of life while preventing suffering and preserving function. All health care workers in the long-term care setting should maintain a high index of suspicion for the presence of depression or depressive symptoms in their patients. Active diagnosis of depression is important because many of the symptoms of depression may also be found in other conditions. Once diagnosed, depression usually responds to treatment with psychotherapy, medications, or a combination of the two.

The purpose of the Depression Clinical Practice Guideline is to assist the interdisciplinary care team through the process of recognition, diagnosis, treatment, and monitoring of depression in the long-term care facility resident. It includes an expanded section on pharmacology, many tables providing strategies to assist in diagnosing and managing depression, and screening tools to assist in recognition of depression. Pharmacotherapy is one component of a multifaceted approach to the management of depression in the long-term care setting. The Pharmacotherapy Companion to the depression clinical practice guideline focuses on the pharmacotherapy of depression. The goals of this companion are to: promote effective treatment of depression in the long-term care facility by helping practitioners select the most appropriate antidepressant for each patient and to eliminate inappropriate pharmacotherapy; outline a process that facilitates optimal prescribing of pharmacotherapy for depression; provide information to all members of the care team concerning the rationale for and choice of antidepressant medications; assist practitioners and other members of the interdisciplinary team in applying the concept of pharmacoeconomics to evaluation of the outcomes of depression pharmacotherapy; differentiate between remission and response when evaluating the clinical outcomes of depression pharmacotherapy; and discuss adverse drug events related to antidepressant pharmacotherapy, including drug-drug and drug-disease interactions.

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