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.
“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.
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.