Response and remission criteria in major depression – A validation of current practice

• Published in: Journal of psychiatric research Vol. 44; no. 15; pp. 1063 - 1068
• Main Authors: Riedel, Michael, Möller, Hans-Jürgen, Obermeier, Michael, Schennach-Wolff, Rebecca, Bauer, Michael, Adli, Mazda, Kronmüller, Klaus, Nickel, Thomas, Brieger, Peter, Laux, Gerd, Bender, Wolfram, Heuser, Isabella, Zeiler, Joachim, Gaebel, Wolfgang, Seemüller, Florian
• Format: Journal Article
• Language: English
• Published: Kidlington Elsevier Ltd 01.11.2010; Elsevier
• Subjects: Adult; Adult and adolescent clinical studies; Area Under Curve; BDI; Biological and medical sciences; Bipolar; CGI; Cut-off; Depression; Depressive Disorder, Major - diagnosis; Depressive Disorder, Major - epidemiology; Depressive Disorder, Major - therapy; Female; Germany; Goals; HAMD-17; HMD-21; Humans; Indexing in process; Inpatients; MADRS; Major depression; Male; Medical sciences; Middle Aged; Mood disorders; Prospective Studies; Psychiatric hospitals; Psychiatric Status Rating Scales; Psychiatry; Psychology. Psychoanalysis. Psychiatry; Psychopathology. Psychiatry; Recurrence; Remission; Reproducibility of Results; Response; ROC Curve; Severity of Illness Index; Time Factors; Treatment Outcome; Validation; Germany; Response; Bipolar; Inpatients; HMD-21; CGI; Major depression; Cut-off; BDI; Remission; MADRS; HAMD-17; Mood disorder; Practice; Depression; Criterion
• ISSN: 0022-3956; 1879-1379
• DOI: 10.1016/j.jpsychires.2010.03.006

Abstract Remission and response were suggested as the most relevant outcome criteria for the treatment of depression. There is still marked uncertainty as to what cut-offs should be used on current depression rating scales. The goal of the present study was to compare the validity of different HAMD, MADRS and BDI cut-offs for response and remission. The naturalistic prospective study was performed in 12 psychiatric hospitals in Germany. All evaluable patients ( n = 846) were hospitalized and had to meet DSM-IV criteria for major depressive disorder. Biweekly ratings were assessed using HAMD-21, MADRS and BDI. A CGI-S score of 1 and a CGI-I score of at least 2 was used as the primary comparative measure of remission and response, respectively. A HAMD-21 cut-off ≤ 7 (AUC: 0.92), HAMD-17 cut-of ≤ 6 (AUC: 0.90), MADRS cut-off ≤ 7 (AUC: 0.94) and BDI cut-off ≤ 12 (AUC: 0.83) were associated with a maximum of specificity and sensitivity for defining remission. A minimum decrease of 47% of the HAMD-21 (AUC: 0.90), ≤57% for HAMD-17 (AUC: 0.89), ≤ 46% for MADRS (0.91) and a decrease of 47% for the BDI baseline score (AUC: 0.78) best corresponded CGI response criteria. Our data largely confirmed currently used remission and response criteria in naturalistically treated patients.