Why Do Some Depressed Outpatients Who Are in Remission According to the Hamilton Depression Rating Scale Not Consider Themselves to Be in Remission?
In treatment studies of depression, remission is typically defined narrowly—based on scores on symptom severity scales. Patients treated in clinical practice, however, define the concept of remission more broadly and consider functional status, coping ability, and life satisfaction as important indicators of remission status. In the present report from the Rhode Island Methods to Improve Diagnostic Assessment and Services (MIDAS) project, we examined how many mildly symptomatic depressed patients in ongoing treatment who did not score in the remission range on the 17-item Hamilton Depression Rating Scale (HAMD) nonetheless considered themselves to be in remission from their depression. Among the mildly symptomatic HAMD nonremitters, we compared the demographic and clinical characteristics of patients who did and did not consider themselves to be in remission.
We interviewed 274 psychiatric outpatients diagnosed with DSM-IV major depressive disorder who were in ongoing treatment. The patients completed measures of psychosocial functioning and quality of life.
Approximately one-quarter of the patients scoring 8–12 on the HAMD considered themselves to be in remission. Compared to patients who did not consider themselves to be in remission, the remitters reported significantly better quality of life, less functional impairment due to depression, higher positive mental health scores, and better coping ability.
Some patients who do not meet symptom-based definitions of remission nonetheless consider themselves to be in remission. The findings raise caution in relying exclusively on symptom-based definitions of remission to guide treatment decision making in clinical practice. Depression and Anxiety 00:1-5, 2012.
Available from: Beppe Micallef-Trigona
- "One of the main outcomes of the included studies was response and remission according to HDRS scale. Response is commonly defined as a reduction in HDRS score of 50% or more whilst remission as a final HDRS score of eight or less . Unfortunately, the studies had varying definitions of response and remission. "
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ABSTRACT: Electroconvulsive therapy (ECT) is the longest standing psychiatric treatment available and has unequivocal benefit in severe depression. However this treatment comes with a number of side effects such as memory impairment. On the other hand, Repetitive Transcranial Magnetic Stimulation (rTMS) is a relatively new form of treatment which has been shown to be efficacious in patients suffering from a number of psychopathologies, including severe depression, with few reported side effects. Due to its potential therapeutic efficacy and lack of side effects, rTMS has gained traction in the treatment of depression, with a number of authors keen to see it take over from ECT. However, it is not clear whether rTMS represents a therapeutic alternative to ECT. This meta-analysis will therefore compare the “gold standard” treatment for severe depression, with the relatively new but promising rTMS. A literature search will be performed with the intention to include all randomised clinical trials. The null hypothesis is that there is no difference in the antidepressant efficacy between the two types of treatment modalities. Statistical analysis of Hamilton Depression Rating Scale (HDRS) scores will be performed.
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ABSTRACT: A 38-year-old woman presents with major depression of I year's duration. She has missed a few days of work during the past month, has not been keeping up with usual household responsibilities, and has withdrawn from friends and social engagements. At the initial evaluation, she scores in the upper end of the moderate range of severity on a self-report depression scale. After 3 months of treatment, she feels much better. She is tolerating the medication well. In the past month, she has missed no days from work, completed her household chores, and engaged in more social activities (though is not fully back to her usual level). Her score on the depression scale improved by 60% after 2 months, although it did not fall into the remission range. That is, she responded to treatment, but continued to have residual symptoms. Her score at the 3-month visit is the same as at the 2-month visit. At the 3-month visit, she is not interested in increasing her medication dosage, adding another medication, or seeing a therapist.
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