May 2019
Depression Is Not Always Major Depressive Disorder
Primary care providers are the practitioners who, most of the time, initially diagnose and treat depression. While depression is very common, not all diagnoses of depression are the same. Numerous disorders may present with significant depression symptoms, but are not major depressive disorder (MDD), including bipolar I and II disorders, cyclothymic disorder, disruptive mood dysregulation disorder, and seasonal affective disorder to name a few. Selecting the most appropriate diagnosis for each patient is important for appropriate treatment and positive outcomes.
Healthcare Effectiveness Data and Information Set (HEDIS®) measures are based on diagnoses. Selecting the appropriate diagnosis may impact quality metric performance. For example, only members with MDD are included in the HEDIS measure for antidepressant medication management (AMM). This measure assesses the continuation of antidepressant medication for 12 weeks in the initiation phase, and 6 months for the continuation and management phase. If a patient has brief situational depression and is inaccurately coded as MDD, it is very likely that as circumstances resolve, they may no longer need or wish to continue the medication. However, once coded with MDD, they remain in the AMM quality measure and contribute to lower scores for medication continuation.
Consider Alternative Diagnoses to MDD
Often, when a person reports being continuously depressed every day for at least two weeks, the diagnosis of major depressive disorder (F32-F33) is used. However, you should also consider using alternative diagnoses when appropriate, for example:
- Adjustment disorder with prolonged depressive reaction (F43.21)
- Dysthymic disorder (F34.1)
- Recurrent brief mood disorder (F38.10)
- Unspecified mood [affective] disorder (F39).
Note: The HEDIS AMM quality measure does not apply to these diagnoses.
Resources Can Support Your Practice
Multiple resources are available to support you in managing patients with depression and other behavioral health diagnoses.
- Magellan Healthcare’s member website
offers various useful behavioral health self-management and educational tools. The member website also provides access to the Magellan Provider Search (provider directory). - American Psychiatric Association Psychiatry Online publishes a guide for treating MDD
. - Magellan’s Behavioral Health toolkit for Medical Providers includes clinical practice guidelines for treatment of patients with depression, as well as screening tools, patient resources and more.
Refer to a Behavioral Health Specialist
At times, the best intervention is for the PCP to refer their patient to a behavioral health provider for specialized psychopharmacologic treatment, psychotherapy, treatments such as electroconvulsive therapy, transcranial magnetic stimulation or support groups.
Other Resources
BCBSTX and Magellan are here to support you in managing patients with depression. You may call Magellan at 1-800-327-7390 for assistance in assigning the most appropriate diagnosis and/or for referral to a behavioral health provider.
Reference and review BCBSTX’s Preventive Care Guidelines and Clinical Practice Guidelines, and the Texas Health Steps for providers website for more information on this and other important topics for treating your patients.
HEDIS is a registered trademark of NCQA.