Pharmacotherapy plus measurement-based care improves depression outcomes

Measurement-based care decreased depression severity, promoted remission and improved medication adherence among patients with depressive disorders treated with pharmacotherapy, according to a study.

“Measurement-based care (MBC) is an evidence-based practice that provides a systematic framework for routine outcome monitoring and has demonstrated benefit in treating a range of psychiatric disorders,” Maria Zhu, MSc, of the department of psychiatry at the University of British Columbia in Canada, and colleagues wrote. “MBC includes (1) routine administration of validated rating scales, either by clinician-rated or patient-reported outcomes (PROs); (2) review of scores by practitioners and patients; and (3) using scores to inform shared clinical decision-making.”

According to the researchers, prior reviews and meta-analyses investigated the efficacy of MBC for mental health outcomes; however, these involved broad diagnoses and varied outcome measures. To their knowledge, no quantitative syntheses included the most rigorous studies that investigated effects of MCB with depressive disorders as the primary diagnosis.

In the current systematic review and meta-analysis, Zhu and colleagues searched six databases through July 1, 2020, using search terms for measurement-based care, depression, antidepressant or pharmacotherapy and randomized controlled trials. They did not apply language restrictions.

In total, they included seven randomized controlled trials, with 2,019 participants, that investigated MBC for depressive disorders and involved pharmacotherapy. Response rate of 50% or greater improvement from baseline to endpoint on a depression scale served as the primary outcome. Remission rate, difference in endpoint severity and medication adherence served as secondary clinical outcomes.

Results of meta-analysis with random-effects models showed no significant difference in response rates between MBC and comparison groups in three studies (OR = 1.66; 95% CI, 0.66-4.17). Zhu and colleagues noted an association between MBC and significantly greater remission rates in five studies (OR = 1.83; 95% CI, 1.12-2.97), lower endpoint severity in five studies (standardized mean difference = 0.53; 95% CI, 0.06-0.99) and greater medication adherence in three studies (OR = 1.68; 95% CI, 1.22-2.3).

“Future RCTs of MBC should examine the effects of MBC for psychotherapy and for depression subgroups (including treatment-resistant depression), and optimization of algorithm-guided MBC,” the researchers wrote. “MBC studies should include outcome measures assessing functioning and quality of life to complement standard symptom measures.

“Further investigation is also necessary to standardize the type and frequency of routine outcome measures used for MBC in depression management,” they added.