Preventive Maintenance

Simplified data collection system reduces chances of relapse.

Like so many others, Pamela* moved to Florida a few years ago largely to escape the brutal winters she experienced during 28 years of living outside of Detroit. But it really wasn’t the cold and snow she sought relief from.

“I actually like the cold weather,” Pamela, 32, reveals. “And as far as I’m concerned, there aren’t too many things more beautiful in this world than a bright sunny morning after a good snowfall the night before. There’s something very serene about that.

“Unfortunately, there just aren’t enough of those days up there. For whatever reason, it always seemed to me like it was 42 degrees and drizzling back home, and that can make for a very gray and dreary day. Those dreary days affected me in a bad way.”

Having fought with depression since she was in her late teens, Pamela found it hard to feel and function normally on such days. That’s why she made the move to Florida, a move she says has helped immensely in her battle.

“I’ve been here for about four years now, and there is no question that I’ve had fewer depressive episodes,” Pamela says. “I’m sure the weather has something to do with that. But I think I owe it more to Dr. Pollack than anyone or anything else.”

Robert Pollack, MD, is the founder of Psychiatric Associates of Southwest Florida, where he uses an array of emerging therapies such as ketamine, transcranial magnetic stimulation (TMS) and theta-burst stimulation (TBS) in his treatment of depression.

Those advanced treatments are used primarily in the fight against treatment-resistant depression, a condition in which depressed patients fail to respond to standard treatments such as antidepressants and psychological counseling.

Whether they’re used alone or in conjunction with one another, ketamine, TMS and TBS have all proven effective, and while Pamela is among those who have benefitted from the therapies, she is also among those who have suffered occasional relapses.

A Valuable Tool

In an effort to reduce relapses, Dr. Pollack recently altered the system that has long been used to monitor patients’ moods by making it easier for patients such as Pamela to access a standard psychological survey tool. That tool is called the Patient Health Questionnaire-9, or PHQ-9. It is a self-administered nine-question screening that allows physicians to measure their patients’ mood and stability. The lower the score the better.

“When we review these tests, we’re looking for an increase in score,” Dr. Pollack says. “That tells us there is something going on that may need to be addressed. And by addressing it, we’re usually talking about giving the patient a booster treatment.

The PHQ-9 only takes a few minutes to complete, and physicians recommend patients take it every two weeks. For years, patients have been asked to take the test at the doctor’s office or respond at home and return by mail, fax or email. However, Dr. Pollack and other psychiatrists discovered these methods were major deterrents with serious consequences.

“The PHQ-9 is a good way to follow people and prevent serious relapses, but the patient needs to be honest and consistent about sending the test back in,” Dr. Pollack explains.

“For someone like me who has been fighting depression almost all my life, this is a potentially life-saving tool.” – Pamela

“Pamela is a good example of what can happen if someone isn’t taking the test and being monitored regularly. When she first came to us, we gave her six treatments of ketamine, after which she was doing very well. We then followed up with her each month for the next three months, and again, she was doing very well. We asked her to do the PHQ-9 test every two weeks. After a while she stopped sending the tests in, which prompted a phone call.

“When we talked with her, we found out she was not doing well. Pamela’s desire to be with friends had begun to wane a bit, she lost focus at work and spent almost an entire weekend in bed at home, sheltered from the outside world.

“We had her come in, and this time, when she took the PHQ-9, the result was a significant jump in score.

“She had really gone downhill, and we needed to give her two boosters to get her back to where she was. Had she been staying in touch with us, we could have caught this decline earlier and she might have only needed one booster session, if that.”

More Accessible PHQ-9

Pamela’s decline and that of a few others is what prompted Dr. Pollack to make the changes in the PHQ-9 system. The changes were designed to make the PHQ-9 more accessible, which he achieved by making the test available on his website.

Now, patients can simply go to, fill out the PHQ-9 form and submit it. Dr. Pollack is hoping the convenience will encourage greater compliance, which can allow him to catch relapses before it’s too late.

“We’ve tried to simplify the process to the point where all someone needs to do is go to our website, fill out the form, hit the button and we have that data,”
Dr. Pollack says. “And that data is so very important. It has strong clinical implications.

“As you can see with someone like Pamela, if she had been filling out the form regularly and providing us with that data, we could have saved her a lot of grief, because we would have caught on much earlier that she was beginning to struggle again.

“Catching that kind of change early is a critical aspect to treating depression, because the more episodes you have, the worse your depression becomes. And the worse the depression becomes, the harder it is to treat.”

Pamela is now filling out the PHQ-9 form regularly, every two weeks as recommended, even when she doesn’t feel a need to because she feels stable and content. She says the habit will ensure she doesn’t have the kind of relapse she already experienced.

“The test takes no time at all to complete, and now there’s no excuse not to take it, because all you do to submit the results is hit a button on your computer keyboard,” she says. “It can’t be any easier.

“For someone like me, who has been fighting depression almost all my life, this is a potentially life-saving tool, and the fact that Dr. Pollack has made it so easy to use just speaks to how much he cares and what kind of physician he is.”

*Patient’s name withheld at her request.
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