The Maudsley Staging Method for treatment-resistant depression: prediction of longer-term outcome and persistence of symptoms.
OBJECTIVE
A recently proposed multidimensional method of staging treatment resistance in depression, the Maudsley Staging Method (MSM), has been shown to predict short-term outcome of treatment. This study tested whether the MSM predicts longer-term clinical outcome. We hypothesized that patients with higher scores on the MSM would experience a worse longer-term outcome in terms of time spent in a depressive episode and level of functional impairment.


METHODS
From May through July of 2008, we followed up patients with treatment-resistant depression discharged from an inpatient unit of an affective disorders service; all had MSM scores previously calculated from preadmission clinical data. We used the Longitudinal Interval Follow-up Evaluation (LIFE) chart to determine the monthly symptomatic course of depression blind to initial MSM scores. We employed a regression model to adjust for various confounding factors, including variable duration of follow-up, to determine the independent association of MSM scores with persistence of depressive disorder.


RESULTS
We assessed 62 of 80 eligible patients (78%) in a median follow-up duration (interquartile range) of 29.5 (19.0-52.5) months. The MSM independently predicted (1) being in an episode for 50% or longer of the follow-up duration (OR = 2.11, 95% CI = 1.25 to 3.57), (2) being in an episode at the time of follow-up assessment (OR = 1.89, 95% CI = 1.17 to 3.05), (3) being persistently in an episode throughout the follow-up period (OR = 2.01, 95% CI = 1.14 to 3.54), and (4) total months spent in a depressive episode (OR = 1.22, 95% CI = 1.06 to 1.40). The MSM also predicted functional impairment. Antidepressant count and the Thase and Rush model did not independently predict persistence of depression or functional impairment.


CONCLUSIONS
The MSM appears to have reasonable predictive validity regarding the longer-term course of illness, particularly persistence of depressive episodes. The MSM may be a useful, and possibly an improved, alternative to existing models of staging of treatment-resistant depression.
Fekadu
Abebaw
A
Institute of Psychiatry, Section of Neurobiology of Mood Disorders, Department of Psychological Medicine and Psychiatry, King's College London, United Kingdom.
Wooderson
Sarah C
SC
Markopoulou
Kalypso
K
Cleare
Anthony J
AJ
D000928:Antidepressive Agents / Q000627:therapeutic use*; D003863:Depression / Q000175:diagnosis / Q000523:psychology; D003866:Depressive Disorder / Q000175:diagnosis* / Q000188:drug therapy; D003865:Major Depressive Disorder / Q000175:diagnosis / Q000188:drug therapy; D004185:Disability Evaluation; D004351:Drug Resistance; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016015:Logistic Models; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care / Q000379:methods* / Q000706:statistics & numerical data; D011379:Prognosis; D011569:Psychiatric Status Rating Scales; D011594:Psychometrics; D012720:Severity of Illness Index
D000928:Antidepressive Agents