At every level of severity, add education, physical activity and behavioral activation to standard treatment recommendations.

This table is designed to translate the PHQ-9 scores into DSM-5 categories and then integrate evidence-based best practice. It does not directly correspond to the PHQ-9 Scoring Guide in Appendix A, "Patient Health Questionnaire (PHQ-9)."

(Cuijpers, 2015; Kuyken, 2015; Biesheuvel-Leliefeld, 2015; Cuijpers, 2014b; Hollon, 2014; Kriston, 2014; Menchetti, 2014; Steinert, 2014; Wiersma, 2014; American Psychiatric Association, 2013: Diagnostic and Statistical Manual of Mental Disorders, 5th Edition; Cuijpers, 2013; Peeters, 2013; Spijker, 2013; van Hees, 2013; von Wolff, 2013; Cuijpers, 2012; Jakobsen, 2012b; Guidi, 2011; Levkovitz, 2011; Oestergaard, 2011; Piet, 2011; Cuijpers, 2010b; Fournier, 2010; Kroenke, 2010; Segal, 2010; Cuijpers, 2009a; Cuijpers, 2009c; Kocsis, 2009a; Dobson, 2008; de Maat, 2008; Imel, 2008; Cuijpers, 2007; Markowitz, 2005; Browne, 2002)

Referral or co-management with mental health specialty clinician if patient has:

• High suicide risk
• Inadequate treatment response
• Other psychiatric disorders such as bipolar, substance abuse, etc.
• Complex psychosocial needs

If the primary care clinician is seeing some improvement, continue working with that patient to increase medication dosage or augment with psychotherapy or medication to reach remission. This can take up to three months. Stay connected through consultation or collaboration, and take the steps needed to get the patient to remission. This can take longer and can take several medication interventions or other steps. The STAR*D study has shown that primary care can be just as successful as specialty care (Trivedi, 2006a).