Tools and strategies for ongoing assessment of depression: a measurement-based approach to remission.

The goal of treatment for major depressive disorder is remission, but many patients do not achieve complete remission, and few reach sustained remission (ie, recovery). However, systematically using clinical strategies such as implementing measurement-based care tactics and following treatment algorithms can improve the accuracy of ongoing assessment of depressive symptoms, better inform treatment decisions, and make sustained remission more likely. Measurement-based care tactics include using assessment tools to measure medication adherence, side effects, depressive symptoms, and suicide risk. Particularly useful in clinical practice are the Frequency, Intensity, and Burden of Side Effects-Rating (FIBSER) questionnaire; the 9-item Patient Health Questionnaire (PHQ-9); and the 16-item Quick Inventory of Depressive Symptomatology (Clinician-Rated or Self-Report versions; QIDS-C or QIDS-SR). The use of these measurements at regular patient visits can be combined with the use of treatment algorithms so that appropriate treatment selections are made on the basis of assessment tool results at critical decision points in follow-up. This article includes an example of how, at each treatment step, assessments can be made and results used to monitor progress toward remission, efficacy of dosage, and tolerability and to make informed, evidence-based treatment decisions. Copyright 2009 Physicians Postgraduate Press, Inc.