Quality Statement 7: Optimizing, Switching, or Adding Therapies

Resources Quality Statements Advisory Committee About

7

Optimizing, Switching, or Adding Therapies

People with major depression who are prescribed antidepressant medication are monitored for 2 weeks for the onset of effects; after this time, dosage adjustment or switching medications may be considered. People with major depression who do not respond to their antidepressant medication after 8 weeks are offered a different or additional antidepressant, psychotherapy, or a combination of antidepressants and psychotherapy.

Background

Monitoring and assessing treatment response is critical to optimizing treatment with antidepressant medication. If inadequate response to medication is noted, it is imperative that the health care provider explain and offer other treatment options. For some specific subpopulations, different time frames may be more appropriate; for example, the elderly may require up to 12 weeks to respond.

What This Quality Statement Means

For Patients

If you start on a new antidepressant, your health care professional should closely monitor the therapeutic effects or side effects of the medication. If your dosage is adjusted or your medications switched, and you’re still not feeling better, another therapy should be tried.

For Clinicians

Assess patients for 2 weeks after they start a new antidepressant to determine their response. If needed, adjust the dosage or switch medications at this time. Complete an additional assessment every 2 weeks up to 6 to 8 weeks. If they do not respond, offer a different antidepressant, psychotherapy, or both.

For Health Services

Ensure the availability of and access to appropriate pharmacotherapy and psychotherapy for people suffering from major depression.

Quality Indicators

Process Indicator

Percentage of people with major depression who receive antidepressant medication who are monitored for 2 weeks for the onset of effects

Denominator: total number of people with major depression who receive antidepressant medication
Numerator: number of people in the denominator who are monitored for the onset of effects for 2 weeks after starting the medication
Data source: local data collection

Percentage of people with major depression who do not respond to their antidepressant medication within 8 weeks who are offered another or additional antidepressant or psychotherapy

Denominator: total number of people with major depression receiving antidepressant medication who have not responded to the medication by 8 weeks of treatment
Numerator: number of people in the denominator who are offered another or additional antidepressant or psychotherapy
Data source: local data collection

Definitions Used Within This Quality Statement

Onset of effects

This is indicated by an improvement in symptoms of at least 20%. This improvement is determined using the same scale used in the initial assessment.

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.

Evidence to Improve Care