Use of Mental Health Telemetry to Enhance Identification and Predictive Value of Early Changes During Augmentation Treatment of Major Depression

Abstract

Standard clinical trial methodology in depression does not allow for careful examination of early changes in symptom intensity. The purpose of this study was to use daily "Mental Health Telemetry" (MHT) to prospectively record change in depressive and anxiety symptoms for depressed patients receiving augmentation treatment, and determine the extent and predictive capacity of early changes. We report results of a 6-week, open-label study of the addition of quetiapine XR (range, 50-300 mg) for adult patients (n = 26) with major depressive disorder who were nonresponsive to antidepressant treatment. In addition to regular study visits, all participants completed daily, wirelessly transmitted self-report ratings of symptoms on a Smartphone. Daily and 3-day moving average mean scores were calculated, and associations between early symptom change and eventual response to treatment were determined. Improvement in depressive and anxiety symptoms was identified as early as day 1 of treatment. Of the total decline in depression severity over 6 weeks, 9% was present at day 1, 28% at day 2, 39% at days 3 and 4, 65% at day 7, and 80% at day 10. Self-report rating of early improvement (≥20%) in depressive symptoms at day 7 significantly predicted responder status at week 6 (P = 0.03). Clinician-rated depressive and anxiety symptoms only became significantly associated with responder status at day 14. In conclusion, very early changes in depressive symptoms were identified using MHT, early changes accounted for most of total change, and MHT-recorded improvement as early as day 7 significantly predicted response to treatment at study end point.

Current State and Future Directions of Technology-Based Ecological Momentary Assessment and Intervention for Major Depressive Disorder: A Systematic Review

“…With the term “compliance”, we refer to the percentage of answered prompts. A few studies did not report this information [35,40,41,42,51,57,60]. However, the majority clearly addressed this issue.…”

A Systematic Review of Cognitive Behavioral Therapy and Behavioral Activation Apps for Depression

“…For example, Shen et al [ 14 ], has recently conducted a systematic review to identify and characterize all the apps available in the app stores to support people with depression, their families and health care professionals, based on the store description. The 53 manuscripts [ 9 , 14 , 15 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , ...…”

Utilizing a Personal Smartphone Custom App to Assess the Patient Health Questionnaire-9 (PHQ-9) Depressive Symptoms in Patients With Major Depressive Disorder

“…While prior studies have demonstrated similar results comparing paper and app PHQ-9 scores within a 2-hour time frame [ 26 ], our study employed three daily survey sessions in a 30-day period for a total of 90 survey sessions per subject. Other studies using apps to assess depressive symptoms have employed rating scales that included either single-point measurements with no follow-up [ 27 , 28 ], combined assessment with personalized feedback [ 25 ], or enhanced treatment [ 18 , 29 ]. These study designs have rendered it more difficult to understand the nature of depressive symptoms over an extended period of time independent of the study intervention.…”

“…Patient adherence and patterns of daily use of smartphone apps by psychiatric patients is largely unknown. Efforts to assess rates of survey adherence include one depression study reporting that 68% of patients completed 75% of surveys [ 18 ]. A recent review of psychiatry-related mobile apps reported generally high adherence rates, notably higher than similar Internet-based interventions [ 16 ].…”