The meaningful change threshold as measured by the 16-item quick inventory of depressive symptomatology in adults with treatment-resistant major depressive and bipolar disorder receiving intravenous ketamine.

Abstract

OBJECTIVE:

.To identify a meaningful change threshold (MCT) in depression outcomes in adults with treatment-resistant major depressive disorder (MDD) or bipolar disorder (BD) receiving intravenous ketamine treatment at a community-based mood disorders center.

METHOD:

.A triangular approach integrating both anchor-based and distributive methods was used to identify meaningful change on the patient-reported Quick Inventory for Depressive Symptoms Self-Report 16-Item (QIDS-SR16) as associated with the Patient Global Impression - Severity (PGI-S). Both the QIDS-SR16 and the PGI-S are self-report measures, and were collected at five timepoints (timepoints were approximately 2-7 days apart).

RESULTS:

.A total of 297 adults with treatment-resistant depression (TRD) as part of either DSM-5-defined MDD or BD were included. The MCT for the QIDS-SR16 revealed that a mean improvement of 3.38 points from baseline was comparable to a 1-point improvement on the PGI-S. Together with an examination of the probability density function, a 3.5-point change is a reasonable MCT (i.e., 1-point PGI-S improvement) for the QIDS-SR16. A 2-point symptomatic improvement on the QIDS-SR16 was associated with no change on the PGI-S.

CONCLUSION:

.A 3.5-point reduction in the QIDS-SR16 represents a MCT based on the PGI-S for adults with treatment-resistant MDD or BD receiving intravenous ketamine treatment at a community-based mood disorders center. These findings are limited by the post-hoc nature of this analysis and open-label case-series design. Measurement-based care decisions by patients, providers and clinicians, as well as cost/reimbursement decisions should include consideration of meaningful change along with conventional objective outcomes.

• Authors: Roger S McIntyre, Orly Lipsitz, Leanna M W Lui, Nelson B Rodrigues, Hartej Gill, Flora Nasri, Rui Ling, Kayla M Teopiz, Roger C Ho, Mehala Subramaniapillai, Kevin Kratiuk, Rodrigo B Mansur, Brett D M Jones, Yena Lee, Joshua D Rosenblat
• Journal: Journal of affective disorders (J Affect Disord) Vol. 294 Pg. 592-596 (11 01 2021) ISSN: 1573-2517 [Electronic] Netherlands
• PMID: 34332360 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2021. Published by Elsevier B.V.

Chemical References

• Ketamine

Topics

• Adult
• Bipolar Disorder (drug therapy)
• Depressive Disorder, Major (drug therapy)
• Depressive Disorder, Treatment-Resistant (drug therapy)
• Humans
• Ketamine (therapeutic use)
• Psychiatric Status Rating Scales
• Self Report