Quantifying Mood Disorders Is a Work in Progress Posted on November 12, 2007 Roger S. McIntyre (bio) underlines the importance of quantifying patient outcomes in the clinical realm.

During the past decade, there has been substantial progress in the development of new treatments for persons who have mood disorders. And I think that an unmet need that we currently have in the field is, "How do I know as a clinician that my patient is improved? How can I compare one treatment to the next? How do I know if in fact the current treatment offers a benefit over the previous treatment?" Well, we won’t know the answer to these questions unless we objectify, we measure, we quantify patient outcome.

One of the great disconnects in psychiatry today is that we quantify outcomes in research, but we rarely quantify outcomes in the therapeutic arena. And it’s been shown beyond any shadow of a doubt that when we quantify, we sharpen the focus in the clinical arena it means better outcomes for patients. So it behooves us to do that. That is to really measure those symptoms. So in that context, it’s important for us to know well what are the goals? What are the therapeutic goals quantitatively, measurably in psychiatry, specifically in mood disorders.

And this is a I would say probably work in progress. And our group has recently reviewed this area looking at a host of definitions that have been proposed for both major depression and bipolar disorder. And although there is no universal agreement as to what defines remission, how it should be operationalized, there is an emerging consensus that fewer symptoms clearly is better than more. And that a cut score on some metric, some depression metric, whether it be the Hamilton Depression metric, the lengthier or more recently, the shorter versions, or for example the MADRAS, which is a well-known depression metric has been put forth as a reasonable starting point, a threshold definition for remission.

In addition, what has been developing over the past several years has been an attempt to define remission in bipolar. And I think defining remission in bipolar really has complexities to it that are unique to this disorder when compared to depression insofar as bipolar disorder is a condition where symptoms can be either depressed or manic. So there’s different dimensions to this illness and so any definition for remission would need to take that into consideration.

So I think that the guiding principle of these efforts is for us as clinicians to measure patient outcomes, to improve overall patient care but from a research perspective what actually constitutes symptomatic abatement, symptomatic elimination.

I think a fascinating research question also which is related, does the absence of symptoms as defined by some cut score in a depression metric or a manic metric, does that translate into the absence of disease activity? So in other words, the patient no longer has chest pains so to speak, but are their arteries still clogged? The patient no longer has depressive symptoms, but is there still underlying pathology? I think this is really our challenge for the next several years in research and also clinical arenas.

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