The Kutcher Adolescent Depression Scale (KADS)

1 Phone number where you (yes, you) can be reached if any tionship, efforts to measure response objectively and subjec- problems develop and arrange to see the patient within 3 4 tively, and careful elicitation of side effects, overall tolerance, days of initiating treatment. ongoing concerns, and satisfaction with treatment. 11. Eleventh increase the dose slowly at no more than 3 5 day intervals until your initial therapeutic dose is We believe that this represents good clinical care that is consis- reached (the expected minimally effective daily dose), then tent with the careful monitoring advocated by the FDA and wait for the required 6 8 weeks at this dose to determine effi- other organizations.

2 This approach will not necessarily totally cacy. Never prescribe medication without at least offering ameliorate the occurrence of behavioral side effects but it may supportive psychotherapy using cognitive or interpersonal cut down their prevalence and will help you quickly identify techniques of support. See the patient weekly and allow for when they occur so that you can intervene. At the very least, telephone check in whenever the dose is increased or be- this approach should cut down the temptation to simply give a tween visits if concerns arise. Always check for and record pill , and in itself that would be a good thing.

3 Possible adverse events at each visit (use the form that you used at baseline so that you can compare symptom changes Dr. Stan Kutcher is Professor of Psychiatry at Dalhousie University over time) and assess improvement at Weeks 2, 4, 5 and 6. in Halifax, Nova Scotia, Canada and Editor of CAPN. Dr. David Gardner is Associate Professor of Psychiatry and Pharmacy at 12. Twelfth take advantage of the placebo response Dalhousie University in Halifax, Nova Scotia, Canada. Dr. Adil (found to be high in most Adolescent Depression trials) That Virani is an Adjunct Professor of Psychiatry and Assistant Professor is, invoke a similar approach to patient care as done in studies of Pharmacy at Dalhousie University.

4 He is a Clinical Pharmacy including frequent face to face contact early in the course of Consultant specializing in pediatric psychopharmacology at the IWK. therapy, the development of a trusting and supportive rela- Health Centre in Halifax, Nova Scotia, Canada. The Kutcher Adolescent Depression Scale (KADS). Sarah Brooks, MD. Many self rated instruments that are Self Rating Scale (DSRS; Birleson cent Depression . This 16 item version often used to measure Depression in ad- 1981), the 30 item Reynolds Adoles- has been tested in two studies (LeBlanc olescents (12 18 years) have limited or cent Depression Scale (RADS; et al.))

5 2002; Brooks et al 2003), one of unknown reliability, validity, and sensi- Reynolds 1987) and the 32 item Mood which enabled assessment of the sensi- tivity to change over time in this age and Feelings Questionnaire (MFQ; tivity to change of each item. As de- group (Brooks & Kutcher , 2001). This Costello & Angold 1988), the sensitiv- scribed below, on the basis of the data is unfortunate because self report ity to change over time of the RADS is from this study, a 11 item version of the scales have the potential to provide not particularly good (Reynolds & Scale was developed, optimized for useful information quickly and cheaply.

6 Coats 1986), and the sensitivity to monitoring treatment effects over time. The self rated Depression scales most change of the MFQ and DSRS does not commonly used with adolescents in- appear to have been examined in Testing the KADS. clude the 21 item Children's Depres- Adolescent samples. The psychometric properties of the 16. sion Inventory (Kovacs, 1992), the original items of the KADS were exam- Development of the KADS. 21 item Beck Depression Inventory ined in a clinical sample of 106 adoles- (BDI; Beck et al. 1961) and the In view of the need for a quickly admin- cents enrolled in an 8 week, randomized, 20 item adult and child versions of the istered, valid, sensitive to change, de- double blind, placebo controlled, Center for Epidemiology Depression pression rating Scale for adolescents, pharmacotherapy trial for major depres- Scale (CES D; Fendrich et al.

7 1990; Stanley Kutcher devised a new self re- sive disorder. Subjects completed the Radloff 1977). None of these scales port Scale the Kutcher Adolescent 16 item KADS and were assessed by a have good discriminative validity in Depression Scale (KADS). His original clinician using the Children's Depression adolescents (Brooks & Kutcher , 2001). version of the KADS contained 16 Rating Scale Revised (CDRS R;. Although several other self report items, which collectively assessed the Poznanski & Mokros 1996), the Clinical scales may be better in this respect for frequency of occurrence and/or the se- Global Impression of Severity Scale example, the 18 item Depression verity of 16 core symptoms of adoles- (CGI Severity), and the Global Assess- CAPN 4.

8 Ment of Functioning (GAF) Scale at Compared to the other clini- 9[5] 2004). (It is currently available in baseline and at weeks 1, 2, 3, 4, 6 and 8. cian rated instruments used in this paper format only.). Fifty three (53) subjects were random- study (the CDRS R and the GAF), ized to active drug and 53 to placebo. Re- subjects' total scores on this 11 item Sarah Brooks, MD, is a medical writer and spectively 47 (89%) and 43 (81%) of version of the KADS exhibited signifi- research analyst, specializing in child and these subjects completed the 8 week cantly greater mean changes from base- Adolescent mental health. Dr. Brooks is cur- study, and clinicians gave respectively 33 line to week 8.

9 Total scores on the rently working for the Department of Psy- (70%) and 31 (72%) of these study com- 11 item KADS also formed moderate chiatry at Dalhousie University. pleters lower CGI Severity ratings at to strong mean within subject correla- Week 8 than at baseline. Given the simi- tions with all of the clinician rated References larity in outcome of the two groups, group scales. These results suggest that the was disregarded in subsequent analyses of 11 item KADS is both a sensitive and Beck, , Ward, C., Mendelson, M., Mock, J., &. Erbaugh, J. (1961). An inventory for depres- the KADS item scores. KADS items were valid measure of changes in Depression sion.

10 Archives of General Psychiatry, 4, 561 571. each ranked on two different estimates of severity over time. Birleson, P. (1981). The validity of depressive sensitivity to change: disorder in childhood and the development of a self rating Scale : A research report. Journal of 1. the absolute change in item score Applications Child Psychol Psychiatry, 22, 73 88. between baseline and Week 8: This was Brooks, , & Kutcher , S. (2001). Diagnosis and The 11 item version of the KADS pre- measurement of Adolescent Depression : A re- calculated for each subject who com- sented here is optimized for monitoring view of commonly utilized instruments.