Depression Questionnaire May Change Treatment Plan

Karla Harby
Medscape Medical News 2006. © 2006 Medscape

October 6, 2006 (New York) — A phase 3 trial involving
1763 patients with depression from 17 psychiatric
centers has found that asking patients to fill out a
short quantitative questionnaire caused their
psychiatrists to change their treatment decisions 40%
of the time. Moreover, 93% of psychiatrists said that
the questionnaire was helpful in their practice.

The 1-page, 9-item Patient Health Questionnaire
(PHQ-9) is based on criteria for major depression and
dysthymic disorder from the Diagnostic and Statistical
Manual of Mental Disorders, Fourth Edition. Originally
designed for primary care physicians, the PHQ-9 is
free for clinical use and available from the Web site
of the MacArthur Initiative on Depression and Primary
Care.

The researchers also found, to their surprise, that
the PHQ-9 showed that rapid remission in depression is
quite rare. Using a score of 5 or lower to define
remission, after 3 months 39% of patients showed a
response to treatment, while only 17% were in
remission, said lead researcher David J. Katzelnick,
MD, Director of Healthcare Technology Systems Inc, in
Madison, Wisconsin. "I think we don't remember the
people who come in once or twice and then disappear,"
he said. "But they count."

Dr. Katzelnick and several researchers from
participating centers presented their findings in a
symposium at the American Psychiatric Association
(APA) 58th Institute on Psychiatric Services.

Of the 1763 patients, 75% were diagnosed with major
depression and the rest with dysthymia. The population
was demographically typical of clinical practice: 67%
of patients were women and 54% were between the ages
of 41 and 64 years. The study recorded 6363 patient
contacts, with 1378 patients having a second follow-up
visit, Dr. Katzelnick said.

Of those physicians who changed their treatment
decisions after reviewing questionnaire scores, the
most common change was to increase the dose of the
antidepressant (45%). Another medication was added 26%
of the time, antidepressant medications were changed
13% of the time, and the psychiatrists paid additional
attention to suicidal ideations in patients 3% of the
time.
The questionnaire was well-received by physicians and
patients alike, Dr. Katzelnick said. The 9 questions
can be answered by the patient in the waiting room, at
home, or during consultation with the physician.
"Clinicians said it did not take [extra] time to do
this, sometimes it actually saved time," Dr.
Katzelnick said.

Harold W. van Lonkhuyzen, MD, medical director of the
Penobscot Bay Medical Center in Rockport, Maine, and a
symposium attendee, has used the PHQ-9 in his own
practice. He was not involved in any of the trials.

"I find it useful for tracking patients' progress, and
for documenting patients' conditions when they return
to their primary care physician," he told Medscape.
"It helps in checking your own impressions, and you do
change management sometimes." But Dr. van Lonkhuyzen
also noted, "This is just one management tool. You
can't forego clinical judgment."

These 1-year trials are the result of a joint project
of the APA, the American Academy of Family Physicians,
and the American College of Physicians. The
uncontrolled trials reported here were conducted in 17
psychiatric treatment centers, with 12.5% of the
psychiatrists in solo practices, 62.5% in group
practices, and 25% being hospital-based. An additional
16 primary care environments participated in similar
trials, but those data were not presented.

Major funding was provided by the APA and from
unrestricted educational grants provided by 6
pharmaceutical companies.

APA 58th Institute on Psychiatric Services: Symposium
5. Presented October 5, 2006.




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