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PATIENT HEALTH QUESTIONNAIRE


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Using the PHQ-9 to Assess Patient Response to Treatment

The goal of acute phase treatment is remission of symptoms as indicated by a PHQ-9 Score of < 5 points.
Patients who achieve this goal enter into the continuation phase of treatment.
Patients who do not achieve this goal remain in the acute phase of treatment and require some alteration in treatment (dose increase, augmentation, combination treatment).
Patients who do not achieve remission after two adequate trials of antidepressants and/or psychological counseling or by 20 to 30 weeks would benefit from a formal or informal psychiatric consultation for diagnostic and management suggestions.

Initial Response after Four - Six weeks of an Adequate Dose of an Antidepressant
PHQ-9 Score	Treatment Response	Treatment Plan
Drop of ≥ 5 points from baseline	Adequate	No treatment change needed Follow-up in four weeks.
Drop of 2-4 points from baseline	Probably Inadequate	Often warrants an increase in antidepressant dose.
Drop of 1 point or no change or increase	Inadequate	Increase dose: Augmentation; Switch; Informal or formal psychiatric consultation; Add psychological counseling.
Initial Response to Psychological Counseling After Three Sessions over Four - Six Weeks
PHQ-9 Score	Treatment Response	Treatment Plan
Drop of ≥ 5 points from baseline	Adequate	No treatment change needed Follow-up in four weeks.
Drop of 2-4 points from baseline	Probably Inadequate	Possibly no treatment change needed. Share PHQ-9 with psychological counselor.
Drop of 1 point or no change or increase	Inadequate	If depression-specific psychological counseling (CBT, PST, IPT*) discuss with therapist, consider adding antidepressant. For patients satisfied in other type of psycholgical counseling, consider starting antidepressant. For patients dissatisfied in other psychological counseling, review treatment options and preferences.

* CBT - Cognitive-Behavioral Therapy; PST - Problem Solving Treatment; IPT- Interpersonal Therapy