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Top 30 Quality Measures

Change Treatment for Non-Responsive Depression Overall Rank: 18
Treatment changes occur for non-responsive depression (e.g., no or minimal response after 4-8 weeks of antidepressant treatment).
Domain : Patients with Mood Disorders
Any of several psychological disorders characterized by abnormal emotional states and including especially major depressive disorder and bipolar disorder. Also called affective disorder.
Rationale
Research studies have shown that antidepressant treatment for major depression will generally show signs of effectiveness within 4 to 6 weeks after initiation of treatment. Practice guidelines recommend that a patient who shows no or minimal response after 4-8 weeks should be reassessed and treatment should be adjusted accordingly. Appropriate clinical responses include diagnostic reassessment, increasing drug dosage, adding a supplemental treatment, or changing treatments. Certain types of psychotherapy are also effective for major depression, however, the evidence supporting a threshold period for reassessment is less clear for these modalities.
Primary Reference
Center for Quality Assessment and Improvement. Staff Sensitivity to Cultural/Ethnic Background. Retrieved July 31, 2006 from the World Wide Web: http://www.cqaimh.org/Report.asp? Code=JCAH0004D &POP=0
Level of Evidence
I: Consistently higher quality studies specifically focused on primary mental health care.

Summarized CommentsAdd Comment
  • A more concrete strategy for changes would help.
  • Four weeks may be too short an interval of time.
  • This is actionable for physicians but not for patients
  • Suggest that treatment intensifies or transfers to depression specialist team when non-responsive.
  • I would suggest that at this point it is more important to ensure non drug therapies are being offered rather than adding more meds.
Variation in Results
Ratings-based Rank
Relevance 26
Actionability 7
Overall Importance 27
 
Stakeholder Rank
Academics 14
Clinicians 14
Consumers 18
Decision Makers 34
 
Special Group Rank
First Nations 12
Rural Areas 25
Federal Stakeholders 3
Regional Rank
BC AB SK MB ON QC NB NS PE NL YT NT NU
42 16 15 53 7 33 99 36 13 34 22 53 37
 
Overall Rank

      

18


SA10d (H668)

 
Distribution of Survey Respondent Ratings
Relevance
100
90
80
70
60
50
40
30
20
10
0
0 0 0 0.96 2.5 3.09 14.04 45.05 34.35
1 2 3 4 5 6 7 8 9
Low High
Actionability
100
90
80
70
60
50
40
30
20
10
0
0 0 0 1.31 4.13 4.7 13.91 48.72 27.23
1 2 3 4 5 6 7 8 9
Low High
Overall Importance
100
90
80
70
60
50
40
30
20
10
0
1.42 17.15 81.44
3 2 1

3 = can live without
2 = nice to have
1 = indispensable

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The views expressed herein do not necessarily represent the official policies of Health Canada