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The Patient Health Questionnaire (PHQ-9) is a self-assessment tool for depression. It has nine parts: one for each of the diagnostic criteria for depression, according to the DSM-IV. PHQ-9 results are scored based on the frequency of depressive symptoms, from 0 (“not at all”) to 3 (“nearly every day”). Clinically, the PHQ-9 is used to monitor the severity of a patient’s depression and/or a patient’s response to treatment.
Transcranial magnetic stimulation (TMS) was approved by the Food and Drug Administration in 2008 as an electromagnetic treatment for depression. Particularly useful in cases of severe depression that have not responded to antidepressant drugs, TMS boasts “significant remission (32.6%) and response (38.4%) rates.” Active Recovery TMS has been treating patients in the Portland area since January 2017.
Identifying the symptoms and understanding the severity of depression has never been more important. For the past four decades, doctors have used the PHQ-9 depression screening tool, a carefully constructed questionnaire, to better understand each patient’s individual condition. But what is PHQ-9 an acronym for? And how does it help treat depression? The PHQ-9 falls under the broader testing tool known as the “Patient Health Questionnaire,” (PHQ). Among various indicators of depression, the PHQ-9 asks patients to rate their symptoms on a scale from 0-3, “not at all” to “nearly every day.” The tallied score indicates the severity of the patient’s depression.
In studies both in the United States and worldwide, transcranial magnetic stimulation (TMS) is an effective treatment for depression, per the PHQ-9 scale.
With the frequency of depression diagnoses in the United States— up to 9 percent of people who seek any form of medical treatment in the US exhibit signs of depression — questionnaires like the PHQ 9 depression screening tool are instrumental in identifying mental illness.
The Patient Health Questionnaire was developed in the 1990s out of the PRIME-MD (Primary Care Evaluation of Mental Disorders) diagnostic tool, through the work of Robert L. Spitzer, MD, Janet B.W. Williams, DSW, and Kurt Kroenke, MD, and a team at Columbia University. The test analyzed the symptoms of 12 mental disorders.
Based on the criteria for major depressive disorder, as specified in the Diagnostic and Statistical Manual of Mental Disorders, the nine areas of the PHQ-9 pinpoint progress during depression treatment. Excepting minor revisions since its creation, the PHQ-9 has remained true to the DSM and is still a trusted system for indicating future diagnoses.
According to the American Psychological Association, studies consisting of 580 interviews with patients determined that those with higher PHQ-9 scores — scores of 10 or higher — were 7 to 13.6 times more likely to receive a depression diagnosis. If a patient scored below a 4 on the scale, the likelihood of having depression was less than 1 in 25.
The PHQ-9 is an important tool for tracking the progress of depression symptoms during and after TMS, a highly effective and non-invasive treatment for major depressive disorder. A 2012 study at Brown University found an impressive 58% of patients participating in a TMS trial reported a significant decrease in depression symptoms, and 37% showed signs of remission by the end of therapy.
Additional TMS studies over the past two decades have coincided with these results, including a Rush University study in 2013 that noted a significant decrease in depressive symptoms in patients, reporting that “TMS is effective in the acute treatment of [major depressive disorder].”
Outside the US, a study that spanned Israel, Europe, Canada and the US in 2009 included a successful 16-week TMS trial with significant remission and response rates as well. The PHQ-9 continues to provide a concrete method for uniformly marking patient progress across all viable treatments.
TMS can alleviate depressive symptoms and even send the illness into remission for many patients, making it a compelling treatment for those seeking a non-medication treatment option for major depressive disorder.