Taking the Measure of Depression

Sometimes, what patients tell us has more to do with how they want us to perceive them than how they truly feel.



Richard J. Metzner, M.D.

Clinical Professor

Semel Institute for Neuroscience and Human Behavior at UCLA

Founder, DepressionConsultant.com

"Carl," a 45 year old salesman, came in for a medication follow-up appointment sounding better than he had in years. He spoke proudly about doing more exercise and less drinking. He had continued taking the bupropion XL150 mg he'd started four years earlier. I was about to end our visit with a recommendation to continue the same treatment and schedule a routine follow-up appointment but decided to give him a depression test just to confirm my impression. The test indicated that Carl was "selling" himself as being better than he really felt. His answers revealed significant residual anxiety and depression. 

It has been well-established that "social desirability bias" often influences people's responses when talking to other people. Getting more accurate data is one reason for using self-administered depression tests. Another is the ability to track progress. A third is the usefulness of test results in guiding treatment and helping patients to understand therapeutic decisions. Combining depression testing with algorithms that recommend treatments based on test scores is a more recent advance. The value of computerized decision support systems (CDSS) for treating depression continues to receive published support. As one report put it: "A CDSS can make measurement-based care strategies accessible and user-friendly for physicians and staff, individualize treatment options according to each patient's circumstances, and provide guideline information at the point of care." 

Using the first psychiatric CDSS available on a mobile device, the Clinaptica iPad app, we and others have seen positive results with a wide variety of patients. Carl's Clinaptica scores and recommendation led to our augmenting his previous treatment with another antidepressant. Carl appeared more hopeful at the end of his appointment because we took the trouble to dig deeper and send him home with a treatment tailored to how he felt rather than what he thought he was supposed to say.

Carl returned a month later saying that the escitalopram we had added to his bupropion had made a big difference. There had been some other positive events in his life, but he felt the SSRI was responsible for the improvement that he was feeling. His improved subjective state was reflected in the normal test scores we elicited when we readministered the Clinaptica app. The app's on-screen message: "Need for change of medication not detected" was especially good to see after we had almost jumped to that conclusion prematurely a month earlier.



Copyright 2012, Scaled Psychiatric Systems, Inc. All rights reserved