Quality Statement 1: Comprehensive Assessment

People suspected to have major depression have timely access to a comprehensive assessment.

Quality Statement 2: Suicide Risk Assessment and Intervention

People with major depression who are at considerable risk to themselves or others, including those who experience psychotic symptoms, receive immediate access to suicide risk assessment and preventive intervention.

Quality Statement 3: Shared Decision-Making

People with major depression jointly decide with clinicians on the most appropriate treatment for them, based on their values, preferences, and goals for recovery. They have access to a decision aid in a language they understand that provides information on the expected treatment effects, side effects, risks, costs, and anticipated waiting times for treatment options.

Quality Statement 4: Treatment After Initial Diagnosis

People with major depression have timely access to initial treatment, including pharmacotherapy or evidence-based psychotherapy (or both) according to their preference, the severity of symptoms, and their ability to tolerate treatment. People for whom adequate trials of pharmacotherapy or evidence-based psychotherapy have not been effective have the option of repetitive transcranial magnetic stimulation.

Quality Statement 5: Adjunct Therapies and Self-Management

People with major depression are advised about adjunct therapies and self-management strategies that can complement pharmacotherapy or psychotherapy.

Quality Statement 6: Monitoring for Treatment Adherence and Response

People with major depression are monitored for the onset of, or an increase in, suicidal thinking following initiation of any treatment. People with major depression have a follow-up appointment with their clinician at least every 2 weeks for at least 6 weeks or until treatment adherence and response have been achieved. After this, they have a follow-up appointment at least every 4 weeks until they enter remission.

Quality Statement 7: Optimizing, Switching, or Adding Therapies

People with major depression who are prescribed medication are monitored for two weeks for the onset of effects; after this time, dosage adjustment or switching medications may be considered. People with major depression who do not experience a response to their medication after 8 weeks are offered a different or additional medication, psychotherapy, or a combination of both.

Quality Statement 8: Continuation of Medication

People taking medication who enter into remission from their first episode of major depression are advised to continue their medication for at least 6 months after remission. People with recurrent episodes of major depression who are taking medication and enter into remission are advised to continue their medication for at least 2 years after remission.

Quality Statement 9: Electroconvulsive Therapy

People with severe major depression and those with difficult-to-treat depression have access to electroconvulsive therapy.

Quality Statement 10: Assessment and Treatment for Recurrent Episodes

People with major depression who have reached full remission but are experiencing recurrent episodes have timely access to reassessment and treatment.

Quality Statement 11: Education and Support

People with major depression and their family members and care partners are offered education on major depression and information regarding community supports and crisis services.

Quality Statement 12: Transitions in Care

People with major depression who transition from one clinician to another have a documented care plan that is made available to them and their receiving clinician within 7 days of the transition, with a specific timeline for follow-up. People with major depression who are discharged from acute care have a scheduled follow-up appointment with a clinician within 7 days.