Defining remission by cut off score on the MADRS: selecting the optimal value.

BACKGROUND Remission from major depression may be conceptualised in terms of a cut-off score on an appropriate rating scale. Candidate values proposed hitherto have not been directly validated. METHOD The relationship between The Clinical Global Impression Scale for Severity (CGI-S) and the Montgomery-Asberg Depression Rating Scale (MADRS) was explored in 684 major depressed patients (1114 observations). The value on the MADRS which had greatest concordance with remission, as defined by the CGI-S, was computed using two models. Concordance between clinician and patient judgements of global illness were also compared. RESULTS AND CONCLUSION The two models yielded optimal definitions of remission of <9 and <10 on the MADRS. Either value offers a workable operationalisation of remission and there is little to choose between them. CLINICAL RELEVANCE The data confirm that MADRS <10 should provide the clinician with a valid, and reasonably objectifiable, target for remission

[1]  M. Philipp,et al.  The definition of remission and its impact on the length of a depressive episode. , 1993, Archives of general psychiatry.

[2]  D J Kupfer,et al.  Conceptualization and rationale for consensus definitions of terms in major depressive disorder. Remission, recovery, relapse, and recurrence. , 1991, Archives of general psychiatry.

[3]  A. Altamura,et al.  The use of antidepressants for long-term treatment of recurrent depression: rationale, current methodologies, and future directions. , 1993, The Journal of clinical psychiatry.

[4]  M. Åsberg,et al.  A New Depression Scale Designed to be Sensitive to Change , 1979, British Journal of Psychiatry.

[5]  D. Kupfer,et al.  The definition and operational criteria for treatment outcome of major depressive disorder. A review of the current research literature. , 1991, Archives of general psychiatry.

[6]  M. Hamilton.  A RATING SCALE FOR DEPRESSION , 1960, Journal of neurology, neurosurgery, and psychiatry.

[7]  D. Baldwin,et al.  A multicenter double-blind comparison of nefazodone and paroxetine in the treatment of outpatients with moderate-to-severe depression. , 1996, The Journal of clinical psychiatry.

[8]  T. Sivakumaran,et al.  A protocol for the pharmacologic treatment of major depression. A field test of a potential prototype. , 1998, Journal of affective disorders.

[9]  J. Angst,et al.  Time course of improvement under antidepressant treatment: A survival-analytical approach , 1993, European Neuropsychopharmacology.

[10]  D. Kupfer.  Management of recurrent depression. , 1993, The Journal of clinical psychiatry.

[11]  T. Gale,et al.  Depression rating scales can be related to each other by simple equations. , 1998, International journal of psychiatry in clinical practice.

[12]  J. Fawcett,et al.  Anxiety syndromes and their relationship to depressive illness. , 1983, The Journal of clinical psychiatry.

[13]  A. Beck,et al.  An inventory for measuring depression. , 1961, Archives of general psychiatry.