Response and remission criteria in major depression--a validation of current practice.
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.
Riedel
Michael
M
Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University Munich, Nussbaumstrasse 7, 80336 Munich, Germany.
Möller
Hans-Jürgen
HJ
Obermeier
Michael
M
Schennach-Wolff
Rebecca
R
Bauer
Michael
M
Adli
Mazda
M
Kronmüller
Klaus
K
Nickel
Thomas
T
Brieger
Peter
P
Laux
Gerd
G
Bender
Wolfram
W
Heuser
Isabella
I
Zeiler
Joachim
J
Gaebel
Wolfgang
W
Seemüller
Florian
F
D000328:Adult; D019540:Area Under Curve; D003865:Major Depressive Disorder / Q000175:diagnosis* / Q000453:epidemiology* / Q000628:therapy; D005260:Female; D005858:Germany; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011569:Psychiatric Status Rating Scales; D012372:ROC Curve; D012008:Recurrence; D015203:Reproducibility of Results; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome