Clinical depression follow-up

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Patients with clinical depression should be followed-up four to six weeks following the initiation of the treatment to assess for improvement of symptoms and treatment adherence.[1][2] This is based on clinical practice guidelines by the Veteran Affairs/Department of Defense (VA/DoD) and American Psychiatric Association.

Follow-up

The Veteran Affairs/Department of Defense (VA/DoD) clinical practice guidelines for management of major depressive disorder recommends the following regarding the follow-up of patients:[1]

  • The follow-up period from the time of initial diagnosis is four to six weeks.
  • At time of follow-up, a repeat PHQ-9 and an evaluation of the risk for suicide should be completed in order to assess treatment response.
  • How well treatment was tolerated, adherence to treatment, other influential medical problems, and psychosocial barriers to therapy should also be addressed at the time of follow-up.

Evidence

Two randomized controlled trials found improved outcomes using 'measurement-based care' to monitor patients.[3][4]

A more recent systematic review by the Cochrane Collaboration did not find benefit from measurement-based care.[5] However, the Cochrane review did not include the Comet trial and the trial by Guo. Comet was excluded for choice of outcome and Gui was not mentioned by the Cochrane.

References

  1. 1.0 1.1 VA/DoD clinical practice guideline for the management of major depressive disorder (MDD). Guideline summary. Washington (DC): Department of Veterans Affairs (U.S.); 2009
  2. American Psychiatric Association (APA). Practice guideline for the treatment of patients with major depressive disorder. 3rd ed. Arlington (VA): American Psychiatric Association (APA); 2010 Oct. 152 p. [1170 references] doi:10.1176/appi.books.9780890423387.654001
  3. Guo T, Xiang YT, Xiao L, Hu CQ, Chiu HF, Ungvari GS; et al. (2015). "Measurement-Based Care Versus Standard Care for Major Depression: A Randomized Controlled Trial With Blind Raters". Am J Psychiatry. 172 (10): 1004–13. doi:10.1176/appi.ajp.2015.14050652. PMID 26315978. Trial registration is not clear
  4. Yeung AS, Jing Y, Brenneman SK, Chang TE, Baer L, Hebden T; et al. (2012). "Clinical Outcomes in Measurement-based Treatment (Comet): a trial of depression monitoring and feedback to primary care physicians". Depress Anxiety. 29 (10): 865–73. doi:10.1002/da.21983. PMID 22807244.
  5. Kendrick T, El-Gohary M, Stuart B, Gilbody S, Churchill R, Aiken L; et al. (2016). "Routine use of patient reported outcome measures (PROMs) for improving treatment of common mental health disorders in adults". Cochrane Database Syst Rev. 7: CD011119. doi:10.1002/14651858.CD011119.pub2. PMID 27409972.