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Monitoring
STEP 9: Monitor response to treatment plan for depression
➤ Use similar screening/diagnostic tools to monitor for relief of
depression symptoms based on changes in screening tool scores.
➤ Within the first year in which a resident is admitted on a psychotropic
medication or after the prescribing practitioner has initiated a
psychotropic medication, the facility must attempt a GDR in two
separate quarters (with at least one month between the attempts),
unless clinically contraindicated. After the first year, a GDR must be
attempted annually, unless clinically contraindicated.
➤ GDR may be indicated when the resident's clinical condition has
improved or stabilized, the underlying causes of the original target
symptoms have resolved, and/or non-pharmacological approaches
have been effective in reducing the symptoms.
➤ If the resident's condition has not responded to treatment or has
declined despite treatment, it is important to evaluate both the
medication and the dose to determine whether the medication should
be discontinued or the dosing should be altered.
➤ With the first episode, continue the medication for 6-12 months
beyond the time of achieving full remission. Relapse rates in the
elderly are higher than in younger populations. For older adults with
frequent relapses or recurrences or who have dysthymic disorder,
long-term treatment may be needed (see Table 4).
Table 4. Phases of Major Depression Disorder
Term Definition
Response Clinically defined as an improvement from the initial onset of depression.
Remission Clinically defined as an experience of being symptom-free from
depression.
Recovery Absence of symptoms for at least 4 months following the onset of
remission.
Relapse A full return of depressive symptoms once remission has occurred–
but before recovery has taken hold.
Recurrence A new distinct depressive episode aer recovery has been attained.
Information regarding PRN antipsychotic and PRN psychotropic medications can
be found in Appendix G with link to Centers for Medicare & Medicaid Services (CMS)
Guidance and F-Tag 758 Free from Unnecessary Psychotropic Meds/PRN Use.
