title: Hamilton depression rating subscales to predict antidepressant treatment outcome in the early course of treatment.
abstract: BACKGROUND
  Hamilton depression rating scale (HAMD) subscales provide an economic alternative for the full scale; however, their ability to detect onset of improvement in the early course of treatment (EI) has not yet been researched. The present study investigated in patients with major depression (MD) whether the subscales are a comparable option to predict treatment remission in the early course of treatment.
  
  
  METHODS
  Based on data from 210 MD patients of a 6-week randomised, placebo-controlled trial comparing mirtazapine (MIR) and paroxetine (PAR), the discriminative and predictive validity of EI for (stable) remission at treatment end was evaluated for seven subscales and the HAMD17 in the total and in treatment subgroups (MIR vs. PAR). Receiver operating characteristics (ROC) curves (at week 2) and the Clinical Global Impression scales (CGI) (at study endpoint) were used to validate the 20% EI criterion for the subscales.
  
  
  RESULTS
  Only the Evans6 and Toronto7 subscale had almost the same predictive value as the HAMD17 (e.g., sensitivities stable remission Evans6/Toronto7: 96/95% vs. 96% HAMD17). The optimal cut-off for EI to predict remission was just below 20% for most subscales and slightly over 20% for stable remission.
  
  
  CONCLUSIONS
  Study sample representativeness, non-independence of subscales, missing external validation criterion, lack of control group.
  
  
  CONCLUSIONS
  The Evans6 and Toronto7 subscales are valuable alternatives in situations, where economic aspects play a larger role. A sum score reduction of ≥20% as definition for EI seems also appropriate for the HAMD subscales, in the total as well as in the antidepressant subgroups.
authors: Department of Psychiatry and Psychotherapy, University Medical Centre Mainz, Mainz, Germany. Electronic address: Isabella.Helmreich@unimedizin-mainz.de.
authors: Isabella
authors: I
authors: Helmreich
authors: Department of Psychiatry and Psychotherapy, University Medical Centre Mainz, Mainz, Germany.
authors: Stefanie
authors: S
authors: Wagner
authors: Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), Mainz, Germany.
authors: Jochem
authors: J
authors: König
authors: Psychology Department, University of Erlangen-Nuremberg, Erlangen, Germany.
authors: Ralf
authors: R
authors: Kohnen
authors: Employee of Merck, Rahway, NJ, USA (at the time of manuscript preparation).
authors: Armin
authors: A
authors: Szegedi
authors: Department of Psychiatry and Psychotherapy, University Medical Centre Mainz, Mainz, Germany.
authors: Christoph
authors: C
authors: Hiemke
authors: Department of Psychiatry and Psychotherapy, University Medical Centre Mainz, Mainz, Germany.
authors: André
authors: A
authors: Tadić
mesh_terms: D000928:Antidepressive Agents / Q000627:therapeutic use*; D003865:Major Depressive Disorder / Q000175:diagnosis* / Q000188:drug therapy*; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D008297:Male; D008803:Mianserin / Q000031:analogs & derivatives / Q000627:therapeutic use; D008875:Middle Aged; D000078785:Mirtazapine; D017374:Paroxetine / Q000627:therapeutic use; D011237:Predictive Value of Tests; D011569:Psychiatric Status Rating Scales; D012372:ROC Curve; D012074:Remission Induction; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000928:Antidepressive Agents; D008803:Mianserin; D017374:Paroxetine; D000078785:Mirtazapine
keywords: Antidepressants; Depression; Early improvement; Hamilton depression rating scale (HAMD(17)); Outcome prediction; Subscales