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Measurement-based care more effective than standard care for depression

Measurement-based care appeared to be more effective than standard care for moderate to severe depression, according to study findings in the American Journal of Psychiatry.

“Recently, measurement-based care has been gaining attention in the treatment of depression because it allows psychiatrists to individualize treatment decisions for each patient based on changes in psychopathology and tolerance of antidepressants,” Tong Guo, MD, of Beijing Anding Hospital, Capital Medical University, Beijing, and colleagues wrote. “Given the frequency of major depression, and the individual as well as societal burden it imposes, evaluation of the effectiveness and cost-saving potential of measurement-based care in a randomized controlled trial is critical, in order to inform clinical care and guidelines. Moreover, measurement-based care strategies are needed that are easily implemented in clinical practice and are scalable.”

Individuals with moderate to severe major depression were randomly assigned to 24 weeks of measurement-based care (ie, guideline and rating-scale based decisions; n = 61) or standard treatment (ie, clinicans’ choice decisions; n = 59). Pharmacotherapy was limited to paroxetine (20 mg to 60 mg per day) or mirtazapine (15 mg to 45 mg per day) for both groups. Hamilton Depression Rating Scale (HAM-D) and the Quick Inventory of Depressive Symptomatology-Self Report (QIDS-SR) measured depressive symptoms.

More individuals who received measurement-based care achieved a response (86.9% vs. 62.7%) and remission (73.8% vs. 28.8%) compared with those who received standard care.

Those who received measurement-based care had significantly shorter time to response (5.6 weeks vs. 11.6 weeks) and remission (10.2 weeks vs. 19.2 weeks) compared with those who received standard care.

Both groups exhibited significant reductions in HAM-D scores, however individuals who received measurement-based care had larger reductions in HAM-D scores (–17.8 vs. –13.6).

The measurement-based care group had significantly more treatment adjustments (44 vs. 23) and higher antidepressant dosages from week 2 to week 24, according to researchers.

Study discontinuation, adverse events and concomitant medications did not differ between groups.

“We found measurement-based care to be a feasible and more effective method than standard treatment for patients with moderate to severe major depression. Measurement-based care not only markedly increased the likelihood and the speed of achieving response and remission, it also did not increase side effect burden, despite higher antidepressant dosages, and it proved to be acceptable to patients,” Guo and colleagues wrote. “Results from this study should inform clinical care delivery to patients with major depression, and its cost-effectiveness should be explored further.” – by Amanda Oldt

Disclosure: Guo reports no relevant financial disclosures. Please see the full study for a list of all researchers’ relevant financial disclosures.