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ADHD Depression – The Kelsey Score

Depression

Depression And ADHD By The Numbers

Years ago on the national speaking circuit I worked with Wyeth, teaching the pharmacologic details to medical colleagues on the office use of antidepressants. I chose to work with Wyeth for the same reason as Shire: My clinical experience with Effexor XR and with Adderall, Vyvanse and Daytrana most often proved superior to other competitive products – and the data, large meta-analytic studies confirmed those office findings.

The Kelsey Score

Missing from those many conversations was an easy way, in the office, to assess clinical depression without performing an entire, state of the research-art review like the Hamilton Depression Inventory. Yes, of the many comorbid conditions most often seen with ADHD, the two most prevalent are 1. Anxiety, and 2. Depression.

Enter my good friend, now passed, Jeff Kelsey, MD PhD, psychopharmacologist and researcher from Emory University in Atlanta.  Jeff researched and published an interesting paper years ago, small sample number [about 70 people as I recall], comparing outcomes of this simple scale with the Hamilton Depression Inventory for office use.

Patient Inquiry

“On a scale with 1 at suicidal, feeling that the world is closing in and apathy is overwhelming, to 10 registering as fantastic – how have you been since I last saw you/recently?” In Jeff’s paper: A score of 7 or more, going up, correlated statistically significantly with 7 or less [full remission from depression] on the HAM-D.

Numbers Matter

As I’ve often pointed out in these CorePsych pages, no answers work every time – but this Kelsey Score proves exceedingly useful to objectify any depression, and works oftentimes to pull away the veil of looking good but feeling like death. My response, and the response I’ve suggested to practitioners for years: if the patient says they’re at a 7 or more, and all else appears well, consider their progress to correlate with remission.  As I commented in this post years ago, numbers make more sense than guessing.

Less than 7, especially 5 and below, often does require an increase in antidepressant meds, an assurance they’re working on key conflictual issues in some therapy, and affirming that the structure exists in their life to preclude further deterioration.

I can’t begin to count how many patients have said at the outset of a med check “I’m doing well,” – and we go on to find out they live at a Kelsey 2 or 3. But like anything else in recovery, the Kelsey Scale only works if you work it. Most importantly, it correlates well with years of clinical experience as a helpful office assessment tool, and for those many in psych-denial it does easily correlate with the HAM-D for utilitarian office use.

Jeff would never have appreciated my calling it the Kelsey Scale, he was that kind of guy. Thanks Jeff for your useful contribution, it’s helped many stay on the path for years.

cp

 

 

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10 Comments
  1. How is Candida treated? My daughter’s doctor only said to take probiotics. Do you have a better protocol?

    • Pamela,
      We dig in and go full out with Nystatin and probiotics and a number of other intervention activities – once we know what we’re treating. Too many overlook associated immunity issues that just keep those I will do a post on it soon, it’s time consuming, requires some experience as the unhappy Herxheimer Reaction can occur. We test for all these supportive measures to ensure comprehensive interventions. See this pdf on our most commonly used tests that drive improved treatment targets: http://corepsych.com/tests14
      cp

  2. Hi Dr Parker, I am blogging you from Sydney in Australia as I wanted to pick your brains when you have a moment – love the blog and all the informative articles btw..

    I am 29yrs old and for years have suffered from a treatment resistant depressive illness – I have tried both SSRI’s and SNRI’s as well as lots of holistic and complementary therapies that you suggest e.g IgG’s against food and Mineral Hair. None of these have worked no matter how diligent I have been in their application.

    I am a healthy, physically fit person with no obvious metabolic / hormonal issues – (I have taken blood tests including Thyroid etc)

    I have been to see this excellent world renown clinic (http://www.blackdoginstitute.org.au) and they advise the following:

    That I have Melancholic Depression which is a distinct clinical entity and that I might respond to either broader action Tricyclic Antidepressants or ECT.

    What are your thoughts and opinions on Tricyclic Antidepressants and ECT in particular?

    • Gayle,
      I sincerely thot I answered your question earlier, sorry for the delay. Those two suggestions live at the very bottom of my next-step list. TCA’s very likely won’t work if none of the other ones work, and ECT, it can help, but you need to look more deeply. The absolutely refractory folks like yourself need additional more comprehensive testing. Did you already test for the Candida Evil? That one lurks down there in the gut far too often… see the links for tests and the yeast questionnaire here: http://corepsych.com/tests14. Take that yeast test! And read this book: Nutrient Power – Walsh
      cp

  3. People are behind in life and don’t have the proper support at home..there is to much stuff that is side tracking us from reaching are goal. I believe it’s because are parents cant keep up with education needed to survive now. Poverty is getting bigger parents are separating. We live subconsciously so when are parents disconnect from us, cause they cant keep up with society it starts to take a toll on the heart then the brain. even if your parents are in the house we still feel the disconnect so we spend money and buy things we don’t need because we are looking for the connect that love we use to get from are parents. so we follow other people and find love in the wrong places. it starts with home life then environment. pills are the last thing u ever want to take. are stimulation used to be in are family come home and share what we did get some knowledge and keep pushing society is whats killing us this is all coming from a uneducated 31 year old man with 2 beautiful daughters and they are just like me.

    • Anthony,
      All of these factors play a part in the overview of causality of challenged lifetimes. Sorting out the biology from the psychology and social issues remains an important challenge and should always be considered in any medical intervention process.
      cp

  4. Dr. Parker,

    I am currently taking 60mg prozac and 30mg methylphenidate a day (OCD/ADD.Depression). I had to switch from Adderall (which actually was more effective initially) because I ended up having an episode of utter complete confusion and trouble thinking after an afternoon dose. I am thinking it had to do with the toxic build up using prozac & adderall as you have suggested can happen.

    How easy is it to switch from 60mg prozac to effexor XR? What about the supposed bad withdrawl effects from Effexor if I had to switch in the future?

    • Sean,
      Very likely the reaction was due to the anticipated drug interaction to Prozac and Adderall. Confusion is often characteristically present when those two are combined, and acute confusion is another manifestation of that trend.

      Effexor XR is more efficacious, most of the time, and the switch is quite easy because you really don’t have to taper Prozac because of the buildup in brain fat. Just start the Effexor slow, build up to the correctly Kelsey result and carry on. Discontinuation occurs with every one of the SSRIs except Prozac and those who have difficulty tapering off most frequently have serious chronic metabolic challenges in the first place – making them brittle w psych meds all around. I haven’t seen a person with difficulty on discontinuation who doesn’t have significant neurotransmitter problems in the first place and use that d/c problem as a marker for recommended neurotransmitter and trace element testing.

      Improved information results in improved outcomes.
      cp

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