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Evidence to Improve Care

6

Monitoring for Treatment Adherence and Response

People with major depression are monitored for the onset of, or an increase in, suicidal thinking following initiation of any treatment. People with major depression have a follow-up appointment with their health care provider at least every 2 weeks for at least 6 weeks or until treatment adherence and response have been achieved. After this, they have a follow-up appointment at least every 4 weeks until they enter remission.


Assessing treatment response is critical to optimizing care. Nonadherence to treatment is common and a major reason for inadequate response to treatment and the recurrence of symptoms. As depression is increasingly conceptualized and treated as a recurrent or chronic condition, efforts to enhance treatment adherence should be encouraged. Additional emphasis should be put on closely monitoring adolescents and young adults (under 25 years of age).

For Patients

Your health care professional should monitor you closely.


For Clinicians

Follow up at least every 2 weeks with people taking antidepressants, for at least 6 weeks or until treatment adherence and response are achieved. Then, follow up every 4 weeks until remission. Provide information on the importance of being consistent and continuing treatment despite improvement or side effects.

Note: People with significant risk factors such as psychotic symptoms and significant side effects from medications must be followed up more frequently or for a longer duration, according to your discretion.


For Health Services

Facilitate the ability of providers to schedule follow-up appointments at regular intervals, and ensure providers are available to actively monitor adolescents and young adults newly started on antidepressant medications.

Process Indicator

Percentage of people with major depression taking antidepressants who are monitored for an onset of, or increase in, suicidal ideation for at least 6 weeks following the initiation of medication

  • Denominator: total number of people with major depression taking antidepressant medication
  • Numerator: number of people in the denominator who are monitored for an onset of, or increase in, suicidal ideation for at least 6 weeks following the initiation of antidepressant medication
  • Data source: local data collection
Response

This is indicated by an improvement in symptoms of at least 50%. This improvement is determined using the same scale used in the initial assessment.


Remission

This is defined as a score below the predetermined threshold on the depression symptom rating scale used at the initial assessment and follow-up.

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