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PHQ-9 guided evaluation, risk stratification, and stepped-care treatment
Major depressive disorder affects over 280 million people globally and is the leading cause of disability worldwide. At Dr. Ruja's clinic, depression assessment begins with structured screening (PHQ-9), thorough differential diagnosis (medical mimics, bipolar screening, grief), and risk stratification for self-harm. Treatment follows a stepped-care model: mild depression with watchful waiting and behavioral activation; moderate depression with psychotherapy ± pharmacotherapy; severe depression with combined treatment and closer monitoring.
Kathmandu Neurology Clinic & Cognitive Center
Authored and reviewed by Dr. Ruja Shrestha (MBBS, MD (Psychiatry), NMC 19766). Evidence-based, no fabricated outcomes.
Major depressive disorder affects over 280 million people globally and is the leading cause of disability worldwide. At Dr. Ruja's clinic, depression assessment begins with structured screening (PHQ-9), thorough differential diagnosis (medical mimics, bipolar screening, grief), and risk stratification for self-harm. Treatment follows a stepped-care model: mild depression with watchful waiting and behavioral activation; moderate depression with psychotherapy ± pharmacotherapy; severe depression with combined treatment and closer monitoring.
Reviewed by Dr. Ruja Shrestha, MBBS, MD — Consultant Psychiatrist & CBT Therapist (NMC 19766), Kathmandu Neurology Clinic. For evaluation, book an appointment.
Depression diagnosis requires depressed mood or anhedonia plus four additional DSM-5 criteria, present for ≥2 weeks, causing functional impairment. However, the clinical assessment goes far beyond checklist criteria: functional impact, sleep and appetite change, concentration difficulties, psychomotor change, guilt, and suicidal ideation must all be quantified. The clinic uses PHQ-9 at intake and follow-up, Columbia Suicide Severity Rating Scale (C-SSRS) for risk, and YMRS to screen for bipolarity before starting antidepressants.
Treatment is matched to severity. Mild depression may respond to behavioral activation alone (scheduling pleasant activities, increasing exercise, reducing withdrawal). Moderate depression benefits from CBT, IPT, or behavioral activation combined with antidepressant medication. Severe depression typically requires combined treatment with closer follow-up and possible referral for ECT or TMS when refractory. All patients receive psychoeducation, safety planning, and relapse prevention.
Guidelines referenced:
NICE CG90 — Depression in adults: treatment and managementAPA Practice Guideline for the Treatment of Patients with Major Depressive Disorder, 3rd EditionRush AJ et al. Acute and longer-term outcomes in depressed outpatients requiring one or several treatment steps: a STAR*D report. Am J PsychiatryContent on this website is for general educational purposes only and does not constitute medical advice, diagnosis, or treatment. It is not a substitute for evaluation by a qualified healthcare professional. Always seek the advice of your physician or other qualified provider with any questions regarding a medical condition. Never disregard professional medical advice or delay seeking it because of something you have read on this website. In case of a medical emergency, contact emergency services immediately. No doctor–patient relationship is established by use of this site or by contacting the clinic through the site.