Using Measurement-Based Care to Improve Outcomes for Patients with Depression

Savvy Psychopharmacology M s.H, age 42, is being treated by her family physician for her second episode of major depressive disorder (MDD).When she was 35, Ms. H experienced her first episode of MDD, which was successfully treated with fluoxetine, 20 mg/d, for 9 months.The current episode began approximately 3 months ago, and there were no known precipitating factors.Because Ms. H had responded well to fluoxetine, her physician reinitiates fluoxetine, 20 mg/d, for 8 weeks.At the 8-week follow-up appointment, the physician notes how much better Ms. H seems to be doing.He says that because she has had such a good response, she should continue the fluoxetine and come back in 3 months.Later that evening, Ms. H reflects on her visit.Although she feels better, she still does not feel normal.In fact, she is not sure that she has really felt normal since before her first depressive episode.Ms. H decides to see a psychiatrist.At her first appointment, the psychiatrist asks Ms. H to complete the Quick Inventory of Depressive Symptoms-Self Rated (QIDS-SR) scale.Her QIDS-SR score is 6, which is consistent with mild residual symptoms of depression. 1 The psychiatrist increases the fluoxetine dosage to 40 mg/d and recom-mends that she complete a course of cognitive-behavioral therapy (CBT).