Brief, unidimensional melancholia rating scales are highly sensitive to the effect of citalopram and may have biological validity: implications for the research domain criteria (RDoC).
BACKGROUND
Most depression rating scales are multidimensional and the resulting heterogeneity may impede identification of coherent biomarkers. The aim of this study was to compare the psychometric performance of the multidimensional 17-item Hamilton Depression Rating Scale (HAM-D17) and the 30-item Inventory of Depressive Symptomatology (IDS-C30) to that of their unidimensional six-item melancholia subscales (HAM-D6 and IDS-C6).


METHODS
A total of 2242 subjects from level 1 (citalopram) of the Sequenced Treatment Alternatives to Relieve Depression (STAR* study were included in the analysis. Symptom change, response and remission rates were compared for HAM-D6 versus HAM-D17 and for IDS-C6 versus IDS-C30. The changes in total scores on these scales were compared to the change in Quality of Life Enjoyment and Satisfaction Questionnaire (QLES-Q) score using correlation analysis.


RESULTS
The response to treatment was significantly greater according to the HAM-D6 and IDS-C6. Furthermore, the correlation of changes in depression-ratings with changes in QLES-Q scores were comparable for the subscales and full scales.


CONCLUSIONS
STAR*D was not designed to answer the research questions addressed in this analysis.


CONCLUSIONS
Our findings indicate that the HAM-D6 and IDS-C6 melancholia scales capture a coherent construct in depression. The syndrome reflected in these scales is unidimensional, sensitive to specific pharmacological intervention, and therefore likely to have biological validity. We therefore believe that "melancholia" thus defined could be a valuable construct under the Research Domain Criteria (RDoC), which specifically aims at identifying the neurobiology underlying mental disorders and providing drugable targets.
Research Unit Department P, Aarhus University Hospital, Risskov, Skovagervej 2, DK-8240 Risskov, Denmark; Unit For Psychiatric Research, Aalborg Psychiatric Hospital, Aalborg University Hospital, Aalborg, Denmark; Depression Clinical and Research Program, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA. Electronic address: soeoes@rm.dk.
Søren D
SD
Ostergaard
Psychiatric Research Unit, Psychiatric Center North Zealand, Copenhagen University Hospital, Hillerød, Denmark.
Per
P
Bech
University of Texas, Southwestern Medical School, Dallas, TX, USA.
Madhukar H
MH
Trivedi
Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA, USA.
Stephen R
SR
Wisniewski
Clinical Sciences, Duke-NUS, Singapore, Singapore.
A John
AJ
Rush
Depression Clinical and Research Program, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
Maurizio
M
Fava
D018687:Antidepressive Agents, Second-Generation / Q000494:pharmacology / Q000627:therapeutic use*; D015283:Citalopram / Q000494:pharmacology / Q000627:therapeutic use*; D003866:Depressive Disorder / Q000175:diagnosis / Q000188:drug therapy / Q000523:psychology; D003865:Major Depressive Disorder / Q000175:diagnosis* / Q000188:drug therapy / Q000523:psychology; D006801:Humans; D011569:Psychiatric Status Rating Scales; D011594:Psychometrics; D011788:Quality of Life; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
D018687:Antidepressive Agents, Second-Generation; D015283:Citalopram
Depression; Psychometrics; Research Domain Criteria