Measurement-Based Care Versus Standard Care for Major Depression: A Randomized Controlled Trial With Blind Raters

• Published in: The American journal of psychiatry 2015-10, Vol.172 (10), p.1004-1013
• Main Authors: Guo, Tong, Xiang, Yu-Tao, Xiao, Le, Hu, Chang-Qing, Chiu, Helen F.K., Ungvari, Gabor S., Correll, Christoph U., Lai, Kelly Y.C., Feng, Lei, Geng, Ying, Feng, Yuan, Wang, Gang
• Format: Article
• Language: English
• Subjects: Adult; Antidepressive Agents - therapeutic use; Clinical Decision-Making; Clinical trials; Depressive Disorder, Major - diagnosis; Depressive Disorder, Major - drug therapy; Female; Humans; Male; Mental depression; Mianserin - analogs & derivatives; Mianserin - therapeutic use; Middle Aged; Paroxetine - therapeutic use; Pharmacology; Pilot Projects; Psychiatric Status Rating Scales; Psychiatry; Severity of Illness Index; Treatment Outcome
• ISSN: 0002-953X; 1535-7228
• DOI: 10.1176/appi.ajp.2015.14050652

Objective:The authors compared measurement-based care with standard treatment in major depression.Methods:Outpatients with moderate to severe major depression were consecutively randomized to 24 weeks of either measurement-based care (guideline- and rating scale-based decisions; N=61), or standard treatment (clinicians’ choice decisions; N=59). Pharmacotherapy was restricted to paroxetine (20–60 mg/day) or mirtazapine (15–45 mg/day) in both groups. Depressive symptoms were measured with the Hamilton Depression Rating Scale (HAM-D) and the Quick Inventory of Depressive Symptomatology–Self-Report (QIDS-SR). Time to response (a decrease of at least 50% in HAM-D score) and remission (a HAM-D score of 7 or less) were the primary endpoints. Outcomes were evaluated by raters blind to study protocol and treatment.Results:Significantly more patients in the measurement-based care group than in the standard treatment group achieved response (86.9% compared with 62.7%) and remission (73.8% compared with 28.8%). Similarly, time to response and remission were significantly shorter with measurement-based care (for response, 5.6 weeks compared with 11.6 weeks, and for remission, 10.2 weeks compared with 19.2 weeks). HAM-D scores decreased significantly in both groups, but the reduction was significantly larger for the measurement-based care group (−17.8 compared with −13.6). The measurement-based care group had significantly more treatment adjustments (44 compared with 23) and higher antidepressant dosages from week 2 to week 24. Rates of study discontinuation, adverse effects, and concomitant medications did not differ between groups.Conclusions:The results demonstrate the feasibility and effectiveness of measurement-based care for outpatients with moderate to severe major depression, suggesting that this approach can be incorporated in the clinical care of patients with major depression.