Measurement-Based Care to Enhance Antidepressant Treatment Outcomes in Major Depressive Disorder: A Randomized Clinical Trial

1. Measurement-based care (MBC) significantly accelerates recovery from major depressive disorder, leading patients to achieve response and remission in half the time compared to standard clinical judgment alone

2. MBC facilitates more assertive and effective dosing without increasing side effects

Evidence Rating Level: 1 (Excellent)

In low and middle-income countries (LMICs) like Pakistan, where access to specialized psychiatric care is limited, effective strategies for managing major depressive disorder (MDD) are critically needed. This multicenter, randomized clinical trial evaluated whether measurement-based care (MBC) using structured self-reports (QIDS-SR16 and FIBSER) to guide antidepressant dosing could accelerate symptom resolution compared to standard care. Among 154 adults with nonpsychotic MDD, those receiving MBC achieved both response (≥50% reduction in HAM-D score) and remission (HAM-D ≤7) in half the time (median 2 weeks and 4 weeks, respectively) of the standard care group (4 weeks and 8 weeks). While final response and remission rates at 24 weeks were similarly high in both groups, MBC facilitated a more rapid initial improvement with higher antidepressant doses, without increasing adverse effects or discontinuation. This demonstrates that MBC is a feasible and effective implementation strategy to significantly accelerate recovery from MDD in resource-limited settings, though its long-term advantage requires further study.

Click to read this study in JAMA Network Open

Image: PD

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