REVIEW OF: Husain MI et al, JAMA Netw Open 2025;8(9):e2529427 STUDY TYPE: RCT
Measurement-based care (MBC) improves psychiatric outcomes in study after study (Lewis et al, JAMA Psychiatry 2019;76(3):324–335). If you need further convincing about MBC for major depressive disorder, here’s a recent RCT.
Pakistani researchers randomized 154 adults with nonpsychotic major depression to MBC or standard care. Everyone received paroxetine or mirtazapine, but only the MBC group completed a symptom scale (Quick Inventory of Depressive Symptomatology) and side effect scale (Frequency, Intensity, and Burden of Side Effects Rating) at each visit. Those scores drove dose adjustments or switches using a structured protocol (available in the online supplement to the article or at ClinicalTrials.gov protocol number NCT05431374). Patients were followed for 24 weeks.
Time to response and remission were both about half as long with MBC. Early on, the MBC group also had more remissions and responses. By week 24, though, rates were similar between groups. MBC patients ended up on higher antidepressant doses and had marginally but significantly greater symptom reduction on the Hamilton Depression Rating Scale (HDRS-17). They also had slightly more visits early in treatment. Adverse effects and discontinuation rates were the same.
CARLAT TAKE The MBC group was seen more often, and the non-MBC group eventually caught up—after months of living with depression. Researchers speculate that this catch-up may have been due to the structured nature of the RCT, since everyone was being regularly assessed with the HDRS. Of course, the Patient Health Questionnaire or other rating scales can be used instead. The trick is to use the chosen scales regularly, and to be prepared to adjust course according to their results, if you want your patients to get better faster.
