Achieving Depression Remission
SOURCE: Zimmerman M, Walsh E, Friedman M, et al. Identifying remission from depression on 3 self-report scales. J Clin Psychiatry 2017;78:2:177-183.
Few clinicians doubt that pharmacotherapies for depression usually are beneficial. On the other hand, many of us probably were too quick to endorse antidepressants based on improvements in symptom scores, without looking at the most important bottom line: attainment of remission. Clinical trial data indicate that for any typical initial antidepressant monotherapy, remission is achieved in only about 30% of patients, thus requiring either substitution or augmentation with another agent. Additionally, whereas clinicians probably assess depression status based on improvements using the “thumbnail sketch” approach, clinical trials employ validated scales, such as Hamilton Depression Rating Scale (HAM-D), Patient Health Questionnaire (PHQ-9), and others.
Zimmerman et al compared three different depression scales to the HAM-D (used as the gold standard) in adults treated as outpatients (n = 153) in the department of psychiatry at Brown University. The three comparator scales were Clinically Useful Depression Outcome Scale (CUDOS), Quick Inventory of Depressive Symptomatology Self Report (QUIDS-SR), and PHQ-9.
By effect size, all four scales showed comparable efficacy of antidepressant treatment. On the other hand, patients were significantly more likely to be scored as in remission by the HAM-D than QUIDS-SR and PHQ-9, and significantly less likely than CUDOS.
Clinicians recently have been advised to consider using formal treatment scores to follow depression, similar to our monitoring of A1c for diabetes or TSH for hypothyroidism. Noting the discrepancy between individual scoring systems, more work may be needed to determine which depression scale fits a particular clinical setting.
Noting the discrepancy between individual scoring systems, more work may be needed to determine which depression scale fits a particular clinical setting.
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