Tools and Strategies for Ongoing Assessment of Depression: A Measurement-Based Approach to Remission

Article Abstract

The goal of treatment for major depressive disorder is remission, but many patients do not achieve complete remission, and few reach sustained remission (ie, recovery). However, systematically using clinical strategies such as implementing measurement-based care tactics and following treatment algorithms can improve the accuracy of ongoing assessment of depressive symptoms, better inform treatment decisions,and make sustained remission more likely. Measurement-based caretactics include using assessment tools to measure medication adherence,side effects, depressive symptoms, and suicide risk. Particularly useful in clinical practice are the Frequency, Intensity, and Burden ofSide Effects-Rating (FIBSER) questionnaire; the 9-item Patient Health Questionnaire (PHQ-9); and the 16-item Quick Inventory of Depressive Symptomatology (Clinician-Rated or Self-Report versions; QIDS-C or QIDS-SR). The use of these measurements at regular patient visits canbe combined with the use of treatment algorithms so that appropriate treatment selections are made on the basis of assessment tool resultsat critical decision points in follow-up. This article includes anexample of how, at each treatment step, assessments can be made and results used to monitor progress toward remission, efficacy of dosage,and tolerability and to make informed, evidence-based treatment decisions.

From the Mood Disorders Research Program and Clinic, Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas.

This article is derived from the planning teleconference series "Tackling Partial Remission to Depression Treatment," which was held in March and April 2009 and supported by an educational grant from Bristol-Myers Squibb Company and Otsuka America Pharmaceutical, Inc.

Dr Trivedi has received grant/research support from Bristol-Myers Squibb, Cephalon, Corcept, Cyberonics, Eli Lilly, Forest, GlaxoSmithKline, Janssen, Merck, the National Institute of Mental Health, the National Alliance for Research in Schizophrenia and Depression, Novartis, Pfizer, Pharmacia & Upjohn, Predix, Solvay, and Wyeth-Ayerst; is an advisor/consultant for Abbott, Akzo (Organon), AstraZeneca, Bayer, Bristol-Myers Squibb, Cephalon, Cyberonics, Fabre-Kramer, Forest, GlaxoSmithKline, Janssen, Johnson & Johnson, Eli Lilly, Meade Johnson, Neuronetics, Parke-Davis, Pfizer, Pharmacia & Upjohn, Sepracor, Solvay, VantagePoint, and Wyeth-Ayerst; and is a member of the speakers boards for Abdi Brahim, Akzo (Organon), Bristol-Myers Squibb, Cephalon, Cyberonics, Forest, GlaxoSmithKline, Janssen, Eli Lilly, Pharmacia & Upjohn, Solvay, and Wyeth-Ayerst.

Corresponding author: Madhukar H. Trivedi, MD, Department of Psychiatry, University of Texas Southwestern Medical Center at Dallas, 5323 Harry Hines Blvd, Dallas, TX 75390-9119 (

J Clin Psychiatry 2009;70(suppl 6):26-31

Volume: 70

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