Skip to main content
SpringerLink
Log in

Measurement-Based Care for Unipolar Depression

  • UNIPOLAR DISORDERS (MICHAEL E. THASE, SECTION EDITOR)
  • Published:
Current Psychiatry Reports Aims and scope Submit manuscript

Abstract

This article outlines the role of measurement-based care in the management of antidepressant treatment for patients with unipolar depression. Using measurement-based care, clinicians and researchers have the opportunity to optimize individual treatment and obtain maximum antidepressant treatment response. Measurement-based care breaks down to several simple components: antidepressant dosage, depressive symptom severity, medication tolerability, adherence to treatment, and safety. Quick and easy-to-use, empirically validated assessments are available to monitor these areas of treatment. Utilizing measurement-based care has several steps—screening and antidepressant selection based upon treatment history, followed by assessment-based medication management and ongoing care. Electronic measurement-based care systems have been developed and implemented, further reducing the burden on patients and clinicians. As more treatment providers adopt electronic health care management systems, compatible measurement-based care antidepressant treatment delivery and monitoring systems may become increasingly utilized.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Katon W, Von Korff M, Lin E, et al. Collaborative management to achieve treatment guidelines. Impact on depression in primary care. JAMA. 1995;273:1026–31.

    Article  PubMed  CAS  Google Scholar 

  2. Kessler RC, Berglund, Demler O, et al. The epidemiology of major depressive disorder: results from the National Comorbidity Survey Replication (NCS-R). JAMA. 2003;289:3095–105.

    Article  PubMed  Google Scholar 

  3. Simon GE, VonKorff M, Wagner EH, Barlow W. Patterns of antidepressant use in community practice. Gen Hosp Psychiatry. 1993;15:399–408.

    Article  PubMed  CAS  Google Scholar 

  4. Trivedi MH, Kern JK, Grannemann BD, et al. A computerized clinical decision support system as a means of implementing depression guidelines. Psychiatr Serv. 2004;55:879–85.

    Article  PubMed  Google Scholar 

  5. Trivedi MH, Kleiber BA. Using treatment algorithms for the effective management of treatment-resistant depression. J Clin Psychiatry. 2001;62:25–9.

    PubMed  Google Scholar 

  6. Ford DE. Managing patients with depression: is primary care up to the challenge? J Gen Intern Med. 2000;15:344–5.

    Article  PubMed  CAS  Google Scholar 

  7. Lin EHB, Von Korff M, Katon W, et al. The role of the primary care physician in patients’ adherence to antidepressant therapy. Med Care. 1995;33:67–74.

    Article  PubMed  CAS  Google Scholar 

  8. Trivedi MH, Baker SM. Clinical significance of monitoring early symptom change to predict outcome. J Clin Psychiatry. 2001;62(S4):27–33.

    PubMed  CAS  Google Scholar 

  9. Trivedi MH, Fava M, Wisniewski SR, et al. Medication augmentation after the failure of SSRIs for depression. N Engl J Med. 2006;354:1243–52.

    Article  PubMed  CAS  Google Scholar 

  10. Biggs MM, Shores-Wilson K, Rush AJ, et al. A comparison of alternative assessments of depressive symptom severity: a pilot study. Psychiatry Res. 2000;96:269–79.

    Article  PubMed  CAS  Google Scholar 

  11. Trivedi MH, Rush AJ, Gaynes BN, et al. Maximizing the adequacy of medication treatment in controlled trials and clinical practice: STAR*D measurement-based care. Neuropsychopharmacology. 2007;32:2479–89.

    Article  PubMed  CAS  Google Scholar 

  12. Trivedi MH, Rush AJ, Wisniewski SR, et al. Evaluation of outcomes with citalopram for depression using measurement-based care in STAR*D: implications for clinical practice. Am J Psychiatry. 2006;163(1):28–40.

    Article  PubMed  Google Scholar 

  13. •• Rush AJ, Trivedi MH, Stewart JW, et al. Combining Medications to Enhance Depression Outcomes (CO-MED): acute and long-term outcomes of a single-blind randomized study. Am J Psychiatry 2011, 168:689–701. This article details the use of ADM MBC in patients with chronic and/or recurrent depression. The screening process, treatment selection, and medication management of patients using ADM MBC to manage medication combinations from the onset of treatment are outlined.

    Article  PubMed  Google Scholar 

  14. Morris DW, Trivedi MH, Husain MM, et al. Indicators of pretreatment suicidal ideation in adults with major depressive disorder. Acta Psychiatrica Scandinavica. 2010;121:480–4.

    Article  PubMed  CAS  Google Scholar 

  15. •• Trivedi MH, Kocsis JH, Thase ME, et al. REVAMP—research evaluating the value of augmenting medication with psychotherapy: rationale and design. Psychopharmacol Bull 2008, 41(4):5–33. This article details the use of ADM MBC in patients with chronic depression. The treatment selection process and use of ADM MBC in treating patients with initial monotherapy, followed by augmentation for partial response and a medication switch for nonresponse are outlined.

    PubMed  Google Scholar 

  16. Rush AJ, Crismon ML, Kashner TM, et al. Texas medication algorithm project, phase 3 (TMAP-3): rationale and study design. J Clin Psychiatry. 2003;64:357–69.

    Article  PubMed  Google Scholar 

  17. Trivedi MH, Rush AJ, Crismon ML, et al. Clinical results for the patient with major depressive disorder in the Texas Medication Algorithm Project. Arch Gen Psychiatry. 2004;61:669–79.

    Article  PubMed  Google Scholar 

  18. • Trivedi MH, Wisniewski SR, Morris DW, et al. Concise Associated Symptoms Tracking scale: a brief self-report and clinician rating of symptoms associated with suicidality. J Clin Psychiatry 2011, 72(6):765–74. This article details a self-report safety measure (CAST) developed to evaluate psychiatric symptoms of the “activation syndrome” believed to be associated with treatment-emergent suicidal thoughts and behaviors.

    Article  PubMed  Google Scholar 

  19. • Trivedi MH, Wisniewski SR, Morris DW, et al. Concise Health Risk Tracking scale: a brief self-report and clinician rating of suicidal risk. J Clin Psychiatry 2011, 72(6):757–64. This article introduces a safety measure developed to screen for and evaluate treatment-emergent suicidal ideation, behavior, and related features. The CHRT and CAST have been used as safety measures in the ADM MBC treatment algorithms.

    Article  PubMed  Google Scholar 

  20. Hamilton M. A rating scale for depression. J Neurology Neurosurgery Psychiatry. 1960;23:56–62.

    Article  CAS  Google Scholar 

  21. Mongomery SA, Asberg MA. A new depression scale designed to be sensitive to change. Br J Psychiatry. 1979;134:382–9.

    Article  Google Scholar 

  22. Rush AJ, Giles DE, Schlesser MA, et al. The inventory of depressive symptomatology (IDS): preliminary findings. Psychiatry Res. 1986;18:65–87.

    Article  PubMed  CAS  Google Scholar 

  23. Rush AJ, Gullion CM, Basco MR, et al. The Inventory of Depressive Symptomatology (IDS): psychometric properties. Psychological Medicine. 1996;26:477–86.

    Article  PubMed  CAS  Google Scholar 

  24. Rush AJ, Trivedi MH, Ibrahim HM, et al. The 16-item Quick Inventory of Depressive Symptomatology (QIDS) Clinician Rating (QIDS-C) and self-report (QIDS-SR): a psychometric evaluation in patients with chronic major depression. Biological Psychiatry. 2003;54:573–83.

    Article  PubMed  Google Scholar 

  25. Trivedi MH, Rush AJ, Ibrahim HM, et al. The Inventory of Depressive Symptomatology, Clinician Rating (IDS-C) and Self-Report (IDS-SR), the Quick Inventory of Depressive Symptomatology, Clinician Rating (QIDS-C) and Self-Report (QIDS-SR) in public sector patients with mood disorders: a psychometric evaluation. Psychological Medicine. 2004;34:73–82.

    Article  PubMed  CAS  Google Scholar 

  26. Beck AT, Ward CH, Mendelson M, et al. An inventory for measuring depression. Archives Gen Psychiatry. 1961;4:561–71.

    CAS  Google Scholar 

  27. Beck AT, Steer RA, Ball R, Ranieri W. Comparison of beck depression inventories IA and II in psychiatric outpatients. J Personality Assessment. 1996;67(3):588–97.

    Article  CAS  Google Scholar 

  28. Zung WWK. A self-rating depression scale. Archives Gen Psychiatry. 1965;12:63–70.

    CAS  Google Scholar 

  29. Carroll BJ, Feinberg M, Smouse PE, et al. The carroll rating scale for depression, 1: development, reliability and validity. Br J Psychiatry. 1981;138:194–209.

    Article  PubMed  CAS  Google Scholar 

  30. Kroenke K, Spitzer RL, Williams JB. The PHQ-9: validity of a brief depression measure. J Gen Intern Med. 2001;16:603–13.

    Article  Google Scholar 

  31. Radloff LS. The CES-D scale: a self-report depression scale for research in the general population. Applied Psychological Measurement. 1977;1(3):385–401.

    Article  Google Scholar 

  32. Wisniewski SR, Rush AJ, Balasubramani GK, et al. A self-rated global measure of the frequency, intensity, and burden of side effects. J Psychiatr Pract. 2006;12(2):71–9.

    Article  PubMed  Google Scholar 

  33. Levine J, Schooler NR. SAFTEE: a technique for the systematic assessment of side effects in clinical trials. Psychopharmacol Bull. 1986;22(2):343–81.

    PubMed  CAS  Google Scholar 

  34. Moynihan R. FDA advisory panel calls for suicide warnings over new antidepressants. BMJ. 2004;328(7435):303.

    Article  PubMed  Google Scholar 

  35. Mann JJ, Kapur S. The emergence of suicidal ideation and behavior during antidepressant pharmacotherapy. Arch Gen Psychiatry. 1991;48(11):1027–33.

    PubMed  CAS  Google Scholar 

  36. Food and Drug Administration: Labeling change request letter for antidepressant medications. Available at http://www.fda.gov.cder/drug/antidepressants/SSRIlabelChange.htm. Last updated: 2003; Accessed December 9, 2005.

  37. Posner K, Oquendo MA, Gould M, et al. Columbia Classification Algorithm of Suicide Assessment (C-CASA): classification of suicidal events in the FDA’s pediatric suicidal risk analysis of antidepressants. Am J Psychiatry. 2007;164:1035–43.

    Article  PubMed  Google Scholar 

  38. Rush AJ, Kraemer HC, Sackeim HA, et al. Report by the ACNP task force on response and remission in major depressive disorder. Neuropsychopharmacology. 2006;31(9):1841–53.

    Article  PubMed  Google Scholar 

  39. Hirschfeld RM, Dunner DL, Keitner G, et al. Does psychosocial functioning improve independent of depressive symptoms? A comparison of nefazodone, psychotherapy, and their combination. Biol Psychiatry. 2002;51(2):123–33.

    Article  PubMed  Google Scholar 

  40. Fava GA, Fabbri S, Sonino N. Residual symptoms in depression: an emerging therapeutic target. Prog Neuropsychopharmacol Biol Psychiatry. 2002;26(6):1019–27.

    Article  PubMed  Google Scholar 

  41. Judd LL, Paulus MP, Zeller P. The role of residual subthreshold depressive symptoms in early episode relapse in unipolar major depressive disorder. Arch Gen Psychiatry. 1999;56(8):764–5.

    Article  PubMed  CAS  Google Scholar 

  42. Paykel ES, Ramana R, Cooper Z, et al. Residual symptoms after partial remission: an important outcome in depression. Psychol Med. 1995;25:1171–80.

    Article  PubMed  CAS  Google Scholar 

  43. Thase ME, Simons AD, McGeary J, et al. Relapse after cognitive behavior therapy of depression: potential implications for longer courses of treatment. Am J Psychiatry. 1992;149:1046–52.

    PubMed  CAS  Google Scholar 

  44. Prien RF, Kupfer DJ. Continuation drug therapy for major depressive episodes: how long should it be maintained? Am J Psychiatry. 1986;143:18–23.

    PubMed  CAS  Google Scholar 

  45. •• Harding KJ, Rush AJ, Arbuckle M et al. Measurement-based care in psychiatric practice: a policy framework for implementation. J Clin Psychiatry 2011, 72(8):1136–1143. This article describes the strengths and weaknesses of MBC and provides a top 10 list for the implementation of MBC into standard clinical practice.

    Article  PubMed  Google Scholar 

  46. Kurian BT, Trivedi MH, Grannemann BD, et al. A computerized decision support system for depression in primary care. Prim Care Companion J Clin Psychiatry. 2009;11(4):140–6.

    Article  PubMed  Google Scholar 

  47. Litzelman DK, Dittus RS, Miller ME, Tierney WM. Requiring physicians to respond to computerized reminders improves their compliance with preventive care protocols. J Gen Intern Med. 1993;8:311–7.

    Article  PubMed  CAS  Google Scholar 

  48. Margolis CZ, Warshawsky SS, Goldman L, et al. Computerized algorithms and pediatricians’ management of common problems in a community clinic. Acad Med. 1992;67:282–4.

    Article  PubMed  CAS  Google Scholar 

  49. McDonald CJ, Hui SL, Smith DM, Tierney WM, Cohen SJ, Weinberger M, et al. Reminders to physicians from an introspective computer medical record. A two-year randomized trial. Ann Intern Med. 1984;100:130–8.

    PubMed  CAS  Google Scholar 

  50. Tierney WM, Overhage JM, Takesue BY, Harris LE, Murray MD, Vargo DL, et al. Computerizing guidelines to improve care and patient outcomes: the example of heart failure. J Am Med Inform Assoc. 1995;1995(2):316–22.

    Article  Google Scholar 

Download references

Disclosure

Dr. Trivedi has served as a consultant for Abbott Laboratories, Akzo (Organon Pharmaceuticals), AstraZeneca, Bayer, Bristol-Myers Squibb, Cephalon, Cyberonics, Eli Lilly and Company, Fabre-Kramer Pharmaceuticals, Forest Pharmaceuticals; GlaxoSmithKline, Janssen Pharmaceutica, Johnson & Johnson, Meade Johnson, Neuronetics, Parke-Davis Pharmaceuticals, Pfizer, Pharmacia & Upjohn, Sepracor, Solvay Pharmaceuticals, VantagePoint, and Wyeth-Ayerst Laboratories; has served on speakers’ bureaus for Abdi Brahim, Akzo (Organon Pharmaceuticals), Bristol-Myers Squibb, Cephalon, Cyberonics, Forest Pharmaceuticals, GlaxoSmithKline, Janssen Pharmaceutica, Eli Lilly and Company, Pharmacia & Upjohn, Solvay Pharmaceuticals, and Wyeth-Ayerst Laboratories; and has received grant support from Bristol-Myers Squibb, Cephalon, Corcept Therapeutics, Cyberonics, Eli Lilly and Company, Forest Pharmaceuticals, GlaxoSmithKline, Janssen Pharmaceutica, Merck & Co., the National Institute of Mental Health, the National Alliance for Research in Schizophrenia and Depression, Novartis, Pfizer, Pharmacia & Upjohn, Predix Pharmaceuticals, Solvay Pharmaceuticals, and Wyeth-Ayerst Laboratories.

Dr. Morris reported no potential conflicts of interest relevant to this article.

Author information

Authors and Affiliations

  1. Department of Psychiatry, The University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX, 75390-9119, USA

    David W. Morris & Madhukar H. Trivedi

Authors
  1. David W. Morris
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Madhukar H. Trivedi
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Madhukar H. Trivedi.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Morris, D.W., Trivedi, M.H. Measurement-Based Care for Unipolar Depression. Curr Psychiatry Rep 13, 446–458 (2011). https://doi.org/10.1007/s11920-011-0237-8

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11920-011-0237-8

Keywords

Search

Navigation