PHQ-9 (source ↗)
Nine-item self-report tool for depressive symptom screening and severity monitoring. Review every response, including the self-harm item, and assess safety directly when indicated.
BH
Brooke Harbor Health System
PMHNP Clinical Learning Environment
Updated July 31, 2026
Condition Guide
Depressive Disorders
Depressive symptoms call for diagnostic clarification, direct safety assessment, and attention to bipolar-spectrum illness, substances, medications, sleep, grief, trauma, and medical contributors. Treatment should reflect severity, functional impact, prior response, patient preferences, access, and the need for timely follow-up.
Rating Scales & Screening Tools
Measure symptoms while continuing the clinical assessment
Use symptom measures to support screening, establish a baseline, and follow change over time while continuing direct diagnostic and safety assessment. For guidance on selecting, administering, and interpreting these tools, see the Toolbox's Rating Scales & Screening.
PHQ-2 (source ↗)
Brief initial screen using depressed mood and loss of interest. A positive screen should lead to a fuller diagnostic and safety assessment.
Beck Depression Inventory-II (source ↗)
Self-report measure of depressive symptom severity. Use according to licensing, administration, and interpretation requirements.
HAM-D (source ↗)
Clinician-rated measure used mainly in specialty and research settings. Reliable scoring requires training and consistent administration.
Medication Classes
Select treatment collaboratively and monitor the whole response
Medication selection should account for severity, prior response, comorbidity, adverse-effect priorities, access, and patient preference. The VA/DoD Major Depressive Disorder guideline and the American College of Physicians guideline provide evidence-based treatment recommendations. For practical support with actual-use histories, interactions, and monitoring, see the Toolbox's Medication Reconciliation & Monitoring. More complex or refractory presentations are addressed in Complex Psychopharmacology & Treatment Resistance.
SSRIs (source ↗)
Common first-line options include sertraline, escitalopram, fluoxetine, and others. Consider adverse effects, interactions, discontinuation symptoms, age, pregnancy, and prior response.
SNRIs (source ↗)
Venlafaxine, desvenlafaxine, and duloxetine may be useful when clinically appropriate. Monitor blood pressure, tolerability, interactions, and discontinuation risk.
Other antidepressants (source ↗)
Bupropion, mirtazapine, vortioxetine, vilazodone, and older agents offer different benefit and adverse-effect profiles. Match the choice to symptoms, comorbidity, safety, and patient priorities.
Augmentation and advanced treatment (source ↗)
Lithium, selected second-generation antipsychotics, ketamine/esketamine, ECT, TMS, and other strategies may be considered after careful reassessment of diagnosis, adequate trials, adherence, and contributing conditions.
Psychotherapy Modalities
Choose a modality that fits the presentation and goals
Evidence-based psychotherapy may be used alone or with medication, depending on severity, treatment history, goals, and access. The American Psychiatric Association's depression resource offers additional clinical and patient education. For help matching an approach to the presentation, see the Toolbox's Psychotherapy Modalities.
Cognitive Behavioral Therapy (training ↗)
Targets patterns among thoughts, emotions, and behavior while developing practical strategies for symptom and relapse management.
Interpersonal Psychotherapy (source ↗)
Focuses on interpersonal transitions, disputes, grief, and role changes associated with depressive episodes.
Behavioral Activation (source ↗)
Uses structured re-engagement with meaningful and reinforcing activity to address avoidance, withdrawal, and reduced function.
Additional approaches (source ↗)
Mindfulness-based cognitive therapy, psychodynamic therapy, and family or couples work may be appropriate depending on the clinical need, recurrence pattern, relationships, and patient preference.
Supplements & Mind-Body Approaches
Integrate adjunctive strategies safely
Adjunctive strategies should be tied to a specific goal and reviewed for evidence, safety, interactions, feasibility, and cost. For guidance on incorporating these approaches into a coordinated plan, see the Toolbox's Treatment Planning.
Movement, sleep, and daily rhythm (source ↗)
Graded exercise, regular sleep-wake timing, meaningful activity, and social connection can support recovery and function when adapted to health status and current capacity.
Bright-light therapy (source ↗)
May be considered for seasonal-pattern depression and selected other presentations. Screen for bipolar-spectrum illness and review timing, eye health, medications, and activation risk.
Nutrient and supplement review (source ↗)
Omega-3 products, SAMe, folate or L-methylfolate, vitamin B12, and other products require attention to evidence, deficiency, dose, quality, interactions, cost, and the reason for use.
St. John's wort (source ↗)
Has substantial interaction potential, variable product quality, serotonergic risk, and important reproductive considerations. Complete a medication and supplement reconciliation before use.