What does the HAMD mean?
Little is known about the clinical relevance of the Hamilton Rating Scale for Depression (HAMD-17) total scores. It is unclear how total scores translate into clinical severity, or what commonly used measures for response (reduction from baseline of ≥ 50% in the total score) and remission (total HAMD-17 score ≤ 7) mean from a clinical perspective. We therefore compared: (a) the percentage and absolute change in the HAMD-17 total scores with Clinical Global Impression-Improvement (CGI-I); (b) the absolute and percentage change in the HAMD-17 total scores with Clinical Global Impression-Severity (CGI-S) absolute change; and (c) the percentage and absolute change in the HAMD-17 total scores with CGI-I in the subgroups of patients with ≤ median and > median HAMD-17 total scores at baseline. The method used was equipercentile linking of HAMD-17 and CGI ratings from 43 drug trials in patients with Major Depressive Disorder (MDD) (n = 7131). Our results confirm the validity of the commonly used measures for remission and response in MDD trials: a CGI-I score of 2 ('much improved') corresponded to a reduction from baseline of > 50% and < 60%, and a CGI-I score of 1 ('very much improved') to a reduction of > 75% and < 85%. The CGI-S score of 1 ('normal., not at all ill') corresponded to the HAMD-17 total score of < 5 and the CGI-S score of 2 ('borderline mentally ill') to the score between 6 and 8. An effect of baseline illness severity was observed.
Klinik für Psychiatrie und Psychotherapie der TU-München Klinikum rechts der Isar Ismaningerstr. 22, 81675 München, Germany. Stefan.Leucht@lrz.tum.de
Stefan
S
Leucht
Hein
H
Fennema
Rolf
R
Engel
Marion
M
Kaspers-Janssen
Peter
P
Lepping
Armin
A
Szegedi
D000328:Adult; D003865:Major Depressive Disorder / Q000175:diagnosis* / Q000188:drug therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011569:Psychiatric Status Rating Scales; D015203:Reproducibility of Results; D012720:Severity of Illness Index; D016896:Treatment Outcome