Hamilton depression rating scale and montgomery–asberg depression rating scale in depressed and bipolar I patients: psychometric properties in a Brazilian sample The responsiveness of the different versions of the Hamilton Depression Scale. An examination of the sensitivity of the six-item Hamilton Rating Scale for Depression in a sample of patients suffering from major depressive disorder. The Montgomery Äsberg and the Hamilton ratings of depression: A comparison of measures St. John's wort extract LI160 for the treatment of depression with atypical features - a double-blind, randomized, and placebo-controlled trial. The 16-Item quick inventory of depressive symptomatology (QIDS), clinician rating (QIDS-C), and self-report (QIDS-SR): a psychometric evaluation in patients with chronic major depression Differentiating moderate and severe depression using the Montgomery-Asberg depression rating scale (MADRS). HAM-D17 and HAM-D6 sensitivity to change in relation to desvenlafaxine dose and baseline depression severity in major depressive disorder. Desvenlafaxine 50 and 100 mg/d in the treatment of major depressive disorder: an 8-week, phase III, multicenter, randomized, double-blind, placebo-controlled, parallel-group trial and a post hoc pooled analysis of three studies. The Hamilton Anxiety Scale: reliability, validity and sensitivity to change in anxiety and depressive disorders. Exactly what does the Hamilton Depression Rating Scale measure? Sensitivity to changes during antidepressant treatment: a comparison of unidimensional subscales of the Inventory of Depressive Symptomatology (IDS-C) and the Hamilton Depression Rating Scale (HAMD) in patients with mild major, minor or subsyndromal depression What does the HAMD mean? Optimal cutoff point of the Hamilton Rating Scale for Depression according to normal levels of social and occupational functioning The Hamilton Depression Scale A 1-year pilot study of vagus nerve stimulation in treatment-resistant rapid-cycling bipolar disorder. Repetitive transcranial magnetic stimulation in combination with citalopram in young patients with first-episode major depressive disorder: A double-blind, randomized, sham-controlled trial
Background The Hamilton Depression Rating Scale ( HAM-D ) and the Montgomery – Asberg Depression Scale ( MADRS ) are used worldwide and considered st and ard scales for evaluating depressive symptoms . This paper aims to investigate the psychometric proprieties ( reliability and validity ) of these scales in a Brazilian sample , and to compare responses in bipolar and unipolar patients . Methods The sample comprised 91 patients with either bipolar I or major depressive disorder from a psychiatric institute at São Paulo , Brazil . Participants were recruited and treated by clinicians through the Structured Interview for DSM-IV criteria  , and had previously been interviewed by a trained , blind tester . Results Both scales indicated good reliability properties ; however , the MADRS reliability statistics were higher than those of the HAM-D for detecting initial symptoms of unipolar depression . Correlation between the tests was moderate . Despite demonstrating adequate validity , neither test achieved the levels of sensitivity and specificity required for identification of a cutoff score to differentiate bipolar I and unipolar patients . Conclusions Both scales demonstrate adequate reliability and validity for assessing depressive symptoms in the Brazilian sample , and are good options to complement psychiatric diagnosis , but are not appropriate for distinguishing between the two affective disorder types In clinical pharmacology , the evidence proving that a drug has a therapeutic effect in a specific medical condition is based on two major elements : superiority of the drug over placebo in r and omized clinical trials within the medical condition under examination , and a systematic relationship between the dose of the drug and the magnitude of the response it elicits . In their overview of antidepressants versus placebo , Khan and Brown ( 1 ) conclude that “ no clear dose-response relationship has been established to date for most of the new antidepressants ” , while the superiority of the antidepressants over placebo in terms of effect size statistics is approximately 0.30 , a level they find “ less than impressive ” . In their review of double-blind , placebo-controlled trials of antidepressants conducted from 1981 to 2008 , Khan et al ( 2 ) observed that the Hamilton Depression Scale ( HAM-D ) had been used as an outcome scale in most of the trials . However , the HAM-D was actually used in two different versions , the 21-item version ( HAM-D-21 ) and the 17-item version ( HAM-D-17 ) . The HAM-D-21 was used in one third of the trials and the HAM-D-17 in two thirds . Unfortunately , authors who use the HAM-D-21 rarely provide information about the results on the HAM-D-17 . Khan and Brown ( 1 ) highlight now that the antidepressant-placebo difference seems to be higher in HAM-D-21 trials compared to the trials in which the HAM-D-17 has been used as outcome measure . This is a tautological finding in so far as the st and ard deviation of this difference is not available , which is the case for most of the trials review ed by Khan et al ( 2 ) . Among the trials collected by Khan et al ( 2 ) it is possible , however , to identify ten publications in which the six-item HAM-D ( HAM-D-6 ) is compared to both HAM-D-17 and HAM-D-21 , or to HAM-D-28 . The HAM-D-6 covers the core symptoms of depression : depressed mood , work and interests , guilt feelings , psychomotor retardation , psychic anxiety , and general somatic ( fatigability ) . These six items have clinical and psychometric validity ( 3 ) . In two of these ten trials , a dose-response relationship was investigated . Fabre et al ( 4 ) showed that sertraline was significantly superior to placebo at all three doses ( 50 , 100 , 200 mg daily ) when using HAM-D-6 , but only at 50 mg daily when using HAM-D-17 . Liebowitz et al ( 5 ) showed that desvenlafaxine was superior to placebo at both 50 and 100 mg daily when using HAM-D-6 , but only at 50 mg daily when using HAM-D-17 . An analysis of all placebo-controlled trials of desvenlafaxine showed that at doses of 200 or 400 mg daily the effect size was negative during the first week of treatment ( superiority of placebo ) when using HAM-D-17 but not when using the HAM-D-6 , implying that the HAM-D-17 includes symptoms which might be side effects of the drug ( 6 ) . In placebo-controlled trials of fluoxetine , over a dose range from 20 to 60 mg daily , the effect size using HAM-D-17 was approximately 0.30 , but when using HAM-D-6 it was approximately 0.40 ( 3 ) . For escitalopram , a dose of 10 mg daily obtained an effect size of 0.38 mg using HAM-D-6 and a dose of 20 mg daily gave an effect size of 0.61 ( 3 ) . Over the past decade , the goal when evaluating the effect of an antidepressant has been the event of remission rather than response ( 7 ) . Remission in major depression is defined as a minimal level of the core symptoms of depression ( 7 ) . The syndrome reflected by the HAM-D-6 is a unidimensional measure for specific drug targets , and a cut-off score below 5 indicates that the individual symptoms of the scale are only present to a very doubtful degree ( remission ) . Khan and Brown ( 1 ) refer to the Sequenced Treatment Alternatives to Relieve Depression ( STAR*D ) as an example of a poor response to citalopram treatment . Indeed , when using the conventional definition of remission ( HAM-D-17 < 8) , only approximately 36 % of the patients  achieved remission . However , when using a HAM-D-6 score of < 5 as the definition of remission , approximately 45 % of the patients in that study achieved remission ( p<0.001 ) ( 8) . From a statistical point of view , failed trials are merely a consequence of insufficient power , as the inability to reject the null hypothesis is inherently associated with low statistical power . This has recently been illustrated in a re- analysis of a failed study which had used the HAM-D-17 to evaluate the effect of erythropoietin as augmentation in patients with treatment-resistant depression ( 9 ) . By focusing on the HAM-D-6 , fewer patients are needed to reject the null hypothesis . Psychometrically , Khan and Brown ( 1 ) correctly focus on the use of the HAM-D-17 as the major factor for the “ less than impressive ” effect size of 0.30 and the lack of a dose-response relationship . However , their solution to go for a larger HAM-D version ( HAM-D-21 ) is not justified . The solution is to go for the brief , clinical ly and psychometrically valid subscale ( HAM-D-6 ) . The use of the HAM-D-6 as outcome measure in placebo-controlled clinical trials of antidepressants increases the effect size to 0.40 , which is indicative of clinical significance . Using the HAM-D-6 as outcome measure , a dose-response relationship has been established for newer antidepressants such as escitalopram and desvenlafaxine . Moreover , fewer patients are then needed to identify antidepressant effect in controlled trials , which has important ethical implication s ( fewer patients need to receive placebo ) . In my opinion , we need to aim at establishing “ dose-remission ” rather than dose-response relationship in future trials of antidepressants . The HAM-D-6 contains the core symptoms of depression by which to define the event of remission OBJECTIVES To compare the sensitivity of the 6-item  Hamilton Rating Scale for Depression  ( HRSD6 ) with the more widely used 17-item  Hamilton Rating Scale for Depression  ( HRSD17 ) in patients suffering from major depressive disorder , with or without melancholia and /or dysthymic disorder . A secondary objective was to compare the sensitivity of the HRSD6 to the Montgomery-Asberg Depression Rating Scale ( MADRS ) . DESIGN Retrospective analysis of 4 clinical trials that tested antidepressant therapies . SETTING Outpatient treatment in a major psychiatric hospital . PARTICIPANTS One hundred and forty-three male and female out patients meeting the criteria of the DSM-III-R or DSM-IV for major depressive disorder . OUTCOME MEASURES HRSD17 , HRSD6 and MADRS . RESULTS The HRSD6 correlated strongly with the HRSD17 , both at baseline and termination of treatment , and for the subgroups of double depression and melancholia . The HRSD6 was also correlated significantly with the MADRS at both measurement times , and for the subgroups . Paired t-tests with the HRSD6 , HRSD17 and MADRS demonstrated equal sensitivity to change over the course of treatment , both in the full sample and in the dysthymic and melancholic subgroups . CONCLUSIONS The HRSD6 appears to be as sensitive to change over treatment as the HRSD17 and the MADRS . A shorter , less time-consuming measure of depression may have utility in clinical practice and research The 17-item Hamilton Rating Scale for Depression  ( HRSD(17 ) ) and the Montgomery Asberg Depression Rating Scale ( MADRS ) are two widely used clinician-rated symptom scales . A 6-item version of the HRSD ( HRSD(6 ) ) was created by Bech to address the psychometric limitations of the HRSD(17 ) . The psychometric properties of these measures were compared using classical test theory ( CTT ) and item response theory ( IRT ) methods . IRT methods were used to equate total scores on any two scales . Data from two distinctly different outpatient studies of nonpsychotic major depression : a 12-month study of highly treatment-resistant patients ( n=233 ) and an 8-week acute phase drug treatment trial ( n=985 ) were used for robustness of results . MADRS and HRSD(6 ) items generally contributed more to the measurement of depression than HRSD(17 ) items as shown by higher item-total correlations and higher IRT slope parameters . The MADRS and HRSD(6 ) were unifactorial while the HRSD(17 ) contained 2 factors . The MADRS showed about twice the precision in estimating depression as either the HRSD(17 ) or HRSD(6 ) for average severity of depression . An HRSD(17 ) of 7 corresponded to an 8 or 9 on the MADRS and 4 on the HRSD(6 ) . The MADRS would be superior to the HRSD(17 ) in the conduct of clinical trials Preliminary data suggest that hypericum extract LI160 is effective in  atypical depression .  Reported is the outcome of an 8-week double-blind , placebo-controlled , r and omized trial of 600 mg LI160 vs. placebo in patients with vegetative features of atypical depression , i.e. hyperphagia or hypersomnia . One-hundred ( 100 ) patients with mild and 100 patients with moderate severity of a major depression according to ICD-10 were r and omized . Patients needed to meet a score of 2 in at least one of the items 22 - 26 of the Hamilton-Depression-Rating-Scale ( HAM-D ) 28-item version and episode duration of at least 3 months . The primary outcome variable was the relative change of the HAM-D(17 ) from Baseline . Secondary outcome variables were the depression sub-score of the Patient Health Question naire ( PHQ-9 ) , the Clinical Global Impression ( CGI ) , a patient 's satisfaction scale , the Hamilton-Anxiety-Scale ( HAM-A ) and the sum score of atypical vegetative symptoms of the HAM-D(28 ) . The percentage reduction of the HAM-D(17 ) for LI160 compared to placebo approached statistical significance ( p=0.051 ) in the Full Analysis Set (FAS)- population . Using the conventional criterion of the absolute reduction of the HAM-D(17 ) significance was achieved ( p<0.05 ) . No significant benefit could be observed for the sum score of the atypical vegetative items of the HAM-D(28 ; ) however , the sum score of the hypersomnia items ( items 22 - 24 ) showed a significant superiority for LI160 . The HAM-A , PHQ-9 , and CGI-I scales demonstrated superiority of LI160 ( p<0.01 ) . Confining the analysis to moderately depressed patients , a highly significant benefit for the primary outcome variable was revealed . The study supports the beneficial effect of LI160 in depression with atypical features and the validity of the definition of atypical depression on the basis of reversed vegetative signs . Further , it identifies the PHQ-9 as a useful outcome variable in this population The 16-item Quick Inventory of Depressive Symptomatology ( QIDS ) , a new measure of depressive symptom severity derived from the 30-item Inventory of Depressive Symptomatology ( IDS ) , is available in both self-report ( QIDS-SR(16 ) ) and clinician-rated ( QIDS-C(16 ) ) formats . This report evaluates and compares the psychometric properties of the QIDS-SR(16 ) in relation to the IDS-SR(30 ) and the 24-item Hamilton Rating Scale for Depression ( HAM-D(24 ) ) in 596 adult out patients treated for chronic nonpsychotic , major depressive disorder .  Internal consistency was high for the QIDS-SR(16 ) ( Cronbach 's alpha = .86 ) , the IDS-SR(30 ) ( Cronbach 's alpha = .92 ) , and the HAM-D(24 ) ( Cronbach 's alpha = .88 ) .  QIDS-SR(16 ) total scores were highly correlated with IDS-SR(30 ) ( .96 ) and HAM-D(24 ) ( .86 ) total scores . Item-total correlations revealed that several similar items were highly correlated with both QIDS-SR(16 ) and  IDS-SR(30 ) total scores . Roughly 1.3 times the QIDS-SR(16 )  total score is predictive of the HAM-D(17 ) ( 17-item version of the HAM-D ) total score . The QIDS-SR(16 ) was as sensitive to symptom change as the IDS-SR(30 ) and HAM-D(24 ) , indicating high concurrent validity for all three scales . The QIDS-SR(16 ) has highly acceptable psychometric properties , which supports the usefulness of this brief rating of depressive symptom severity in both clinical and research setting BACKGROUND MADRS cut-off scores for moderate and severe depression were estimated in relation to the Hamilton Depression Rating Scale ( HAMD(17 ) ) and the Clinical Global Impressions Scale ( CGI ) . METHOD HAMD(17 ) , MADRS , and CGI ratings from patients with major depression ( DSM-IV ) were analyzed ( N=85 ) . Receiver operating characteristics ( ROC ) curves were applied . RESULTS Mean age was 51.4+/-14.5 years , 69 % were female .  Mean MADRS scores were 23.4+/-13.2 , HAMD(17 ) , MADRS , and CGI scores were highly correlated ( r>0.85 ; P<0.0001 ) . Best separation between moderate and severe depression according to CGI criteria was achieved with a MADRS score of 31 ( sensitivity 93.5 % , specificity 83.3 % ) . LIMITATIONS Studies to vali date severity gradations including DSM-IV or ICD-10 diagnostic severity categories are recommended . CONCLUSIONS Empirically based MADRS cut-off scores to separate moderate from severe depression on the basis of HAMD(17 ) and CGI severity ratings in patients with major depression were yielded INTRODUCTION This retrospective analysis compared sensitivity to change on the 17-item and 6-item Hamilton Rating Scales For Depression ( HAM-D ( 17 ) and HAM-D ( 6 ) , respectively ) in relation to antidepressant dose and baseline depression severity . METHODS Data were derived from 6 r and omized , double-blind , placebo-controlled , 8-week trials of  fixed-dose desvenlafaxine  ( 50 , 100 , 200 or 400 mg/d ) for major depressive disorder .  HAM-D ( 17 ) and HAM-D ( 6 ) effect sizes were assessed . RESULTS HAM-D ( 17 ) effect sizes were negative ( favoured placebo ) for higher desvenlafaxine doses ( 200 - 400 mg/d ) at week 1 , but were positive for all doses after week 2 , with no clear dose-response pattern . However , HAM-D ( 6 ) effect sizes were positive for all doses at all weeks . Effect sizes were consistently greater for HAM-D ( 6 ) vs. HAM-D ( 17 ) , regardless of time spent under therapy . Effect sizes were greater for HAM-D ( 6 ) vs. HAM-D ( 17 ) for all desvenlafaxine doses among patients with baseline HAM-D ( 17 ) < 25 , but not among patients with baseline HAM-D ( 17 ) ≥ 25 . DISCUSSION The HAM-D ( 6 ) demonstrated greater sensitivity to change and robustness than the HAM-D ( 17 ) , supporting the greater homogeneity of the HAM-D ( 6 ) BACKGROUND Major depressive disorder ( MDD ) is a common , chronic illness associated with substantial disability and economic burden . Although a number of effective antidepressants are available , the need for new medications that are effective and well tolerated remains . OBJECTIVE The aim of this study was to compare the efficacy and tolerability of fixed-dose desvenlafaxine 50 and 100 mg/d with placebo for MDD . A post hoc pooled analysis was conducted to evaluate this study in the context of all similarly design ed , completed studies with the 2 doses . METHODS This was an 8-week , Phase III , r and omized , double-blind , duloxetine-referenced , placebo-controlled , parallel-group trial conducted in 21 centers across the United States .  Duloxetine was included for assay sensitivity as a positive control ; the study was not design ed or powered to compare desvenlafaxine with duloxetine .  Participants were out patients aged > or = 18 years with Diagnostic and Statistical Manual of Mental Disorders , Fourth Edition-defined MDD and a 17-item Hamilton Rating Scale for Depression ( HAM-D(17 ) ) score > or = 20 . Patients were r and omly assigned at baseline to fixed-dose desvenlafaxine ( 50 or 100 mg/d ) , fixed-dose duloxetine ( 60 mg/d ) , or placebo . The primary outcome measure was HAM-D(17 ) total score at the final evaluation . Additional measures included the Clinical Global Impressions-Improvement ( CGI-I ) score , Montgomery Asberg Depression Rating Scale ( MADRS ) score , Clinical Global Impressions-Severity ( CGI-S ) score , and 6-item Hamilton Rating Scale for Depression , Bech version ( HAM-D(6 ) ) . Tolerability assessment s included discontinuation rates , adverse events ( AEs ) , vital signs , and laboratory tests . The post hoc pooled analysis was performed using data from the current study and 2 previously published , positive studies that compared the efficacy and tolerability of desvenlafaxine 50 and 100 mg/d with placebo for MDD . The design and method ologies of the 2 studies were similar to the methodology of the current trial , other than not including a reference compound . RESULTS Of the 925 patients who were screened , 287 did not meet entry criteria , and 638 patients enrolled in the study ; the intent-to-treat ( ITT ) population included 615 patients who were evaluated for efficacy ( mean [ SD ] age range , 38.8 - 40.7 [ 12.1 - 13.2 ] years ; mean weight range , 83.3 - 87.0 [ 22.8 - 23.9 ] kg ; female sex , 398 [ 64.7 % ] ; white race , 458 [ 74.5 % ] ) . The primary end point did not reach significance based on the global F test for controlling multiplicity of the desvenlafaxine doses . Based on pairwise comparison , significantly greater improvements on the HAM-D(17 ) were observed in the desven-lafaxine 100 mg/d ( -10.5 ; P = 0.028 , unadjusted for multiple comparisons ) and duloxetine 60 mg/d groups ( -10.3 ; P = 0.047 ) compared with placebo ( -8.7 ) . Desvenlafaxine 100 mg/d and duloxetine 60 mg/d were associated with significantly better scores compared with placebo on the CGI-I , MADRS , CGI-S , and HAM-D(6 ) . No significant differences were observed in any scale between the desvenlafaxine 50 mg/d and placebo groups . Discontinuation rates due to AEs were 5 % , 7 % , 13 % , and 6 % for the desvenlafaxine 50-mg/d , desvenlafaxine 100-mg/d , duloxetine 60-mg/d , and placebo groups , respectively . The ITT population from all 3 studies in the pooled analysis consisted of 1388 patients ( mean [ SD ] age range , 38.8 - 45.7 [ 12.1 - 12.6 ] years ; mean weight range , 73.1 - 87.0 [ 17.6 - 23.9 ] kg ; female sex , 896 [ 64.6 % ] ; white race , 1136 [ 81.8 % ] ) . Significantly greater improvements on the HAM-D(17 ) were observed for desvenlafaxine 50 mg/d ( -11.5 ; P < 0.001 ) and 100 mg/d ( -11.8 ; P < 0.001 ) versus placebo ( -9.6 ) . Both doses were significantly better than placebo on the CGI-I , MADRS , and HAM-D(6 ) . CONCLUSIONS The current study failed to meet its primary efficacy end point based on the a priori analysis plan . Desvenlafaxine was generally well tolerated . A post hoc pooled analysis of this trial and 2 previously published trials with both desvenlafaxine 50 and 100 mg/d found both doses to be effective for MDD compared with placebo . Clinical Trials.gov Identifier : 00384033 The  Hamilton Anxiety Scale ( HAM-A ) was tested for reliability and validity in two different sample s , one sample ( n = 97 ) defined by anxiety disorders , the other sample ( n = 101 ) defined by depressive disorders . The reliability and the concurrent validity of the HAM-A and its subscales proved to be sufficient . Internal validity tested by latent structure analysis was insufficient . The major problems with the HAM-A are that ( 1 ) anxiolytic and antidepressant effects can not be clearly distinguished ; ( 2 ) the subscale of somatic anxiety is strongly related to somatic side effects . The applicability of the HAM-A in anxiolytic treatment studies is therefore limited . More specific anxiety scales are needed The purpose of this study is to evaluate empirical criticism of the psychometric properties of the Hamilton Depression Rating Scale ( HDRS ) by undertaking an " internal construct validity " evaluation . Individual symptom responses for the HDRS were obtained from 370 patients meeting Research Diagnostic Criteria for major depression . A multidimensional normal item response theory ( IRT ) model was used to assess the dimensionality of the HDRS and estimate corresponding item parameters which were then expressed as factor loadings and item thresholds . The analysis yielded a five-dimensional solution . The first dimension ( depressed mood , guilt , suicide , work and interests , agitation , psychic anxiety , somatic anxiety , and loss of libido ) appeared to define global depression severity . These results are consistent with other published factor analytic studies and provide further justification for thinking that the  HDRS total score is a weak index of depressive syndrome severity . The findings provide a benchmark by which the adequacy of future results may be judged , because the multidimensional IRT model does not suffer from the statistical limitations that arise when applying traditional factor analytic methods to discrete symptom ratings In the efficacy evaluation of antidepressant treatments , the total score of the Hamilton Depression Rating Scale ( HAMD ) is still regarded as the ‘ gold st and ard ’ . We previously had shown that the Inventory of Depressive Symptomatology ( IDS ) was more sensitive to detect depressive symptom changes than the HAMD17 ( Helmreich et al. 2011 ) . Furthermore , studies suggest that the unidimensional subscales of the HAMD , which capture the core depressive symptoms , outperform the full HAMD regarding the detection of antidepressant treatment effects . The aim of the present study was to compare several unidimensional subscales of the HAMD and the IDS regarding their sensitivity to changes in depression symptoms in a sample of patients with mild major , minor or subsyndromal depression ( MIND ) . Biweekly IDS-C28 and HAMD17 data from 287 patients of a 10-week r and omised , placebo-controlled trial comparing the effectiveness of sertraline and cognitive – behavioural group therapy in patients with MIND were converted to subscale scores and analysed during the antidepressant treatment course . We investigated sensitivity to depressive change for all scales from assessment -to- assessment , in relation to depression severity level and placebo – verum differences . The subscales performed similarly during the treatment course , with slight advantages for some subscales in detecting treatment effects depending on the treatment modality and on the items included . Most changes in depressive symptomatology were detected by the IDS short scale , but regarding the effect sizes , it performed worse than most subscales . Unidimensional subscales are a time- and cost-saving option in judging drug therapy outcomes , especially in antidepressant treatment efficacy studies . However , subscales do not cover all facets of depression ( e.g. atypical symptoms , sleep disturbances ) , which might be important for comprehensively underst and ing the nature of the disease depression . Therefore , the cost-to-benefit ratio must be carefully assessed in the decision for using unidimensional subscales 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 The main goal in the treatment of major depressive disorder ( MDD ) is to achieve remission , defined as the resolution of symptoms and the return to normal levels of functionality . However , the clinical assessment of remission is usually merely based on scores of symptomatic rating scales . One of the most widely used scales to measure remission is the HAM-D(17 ) , in which remission is defined as a score ≤ 7 . Nevertheless , several studies have shown that this cutoff could be too high when also functioning is considered . This is a post-hoc analysis of a 6-month prospect i ve study , performed over a sample of 292 Spanish patients with MDD , in order to find the optimal cutoff in the HAM-D(17 ) scale , considering normal levels of functionality , evaluated by the SOFAS ; by means of plotting Receiver Operating Characteristics ( ROC ) curves . Our results show that a score of ≤ 5 maximized both sensitivity and specificity for identifying normal levels of functionality with respect to other scores , and thus agree with previous works , which suggest that a cutoff ≤ 7 might be too high to consider remission in patients with MDD , when normal levels of functioning are taken into account The consistency of the Hamilton Depression Scale  ( HDS ) as a measure of the severity of depressive states has been examined when the scale was used weekly during a trial with imipramine . By use of logistic models ( Rasch ) the consistency of the HDS has been considered across patient‐variables as age , sex , plasma levels of imipramine , and diagnosis . The results showed that the original 17‐item HDS was without adequate consistency , i.e. the total score of the sample of items was no one‐dimensional measure of depressive states . However , a melancholia subscale of the HDS contained items the total of which can be used to compare patients quantitatively , although in some part of the analysis one of these items showed ceiling effect . It was concluded that the melancholia sub‐scale ( containing the items depressed mood , guilt , work and interests , retardation , psychic anxiety , and general somatic symptoms ) can form the basis for further improvements in the field of quantitative rating scales for depressive states OBJECTIVE Vagus nerve stimulation ( VNS ) appears to be an effective treatment option for patients with treatment-resistant unipolar and bipolar depression . The aim of the present study was to investigate the efficacy of VNS in a group of patients with treatment-resistant rapid-cycling bipolar disorder ( RCBD ) who were excluded from previous trials . METHOD Nine out patients with a DSM-IV-TR diagnosis of treatment-resistant RCBD were treated for 40 weeks with open-label VNS . The first patient was enrolled in June 2001 , and the last patient completed the study in July 2005 . Patients recorded their depression and mania mood symptoms on a daily basis throughout the study using the National Institute of Mental Health prospect i ve life charting methodology and daily mood ratings . Patients were assessed every 2 weeks during the 2-month baseline period before device activation , every 2 weeks for the remaining 40 weeks of the study , and at the end of the study with the 24-item Hamilton Rating Scale for Depression ( HAM-D-24 ) , the 10-item Montgomery-Asberg Depression Rating Scale ( MADRS ) , the Young Mania Rating Scale ( YMRS ) , the Clinical Global Impressions ( CGI ) scale , the Global Assessment of Functioning ( GAF ) scale , and the 30-item Inventory of Depressive Symptomatology Self-Report ( IDS-SR-30 ) . Any adverse events or device complications were also recorded at each visit . The prospect i ve life charts were analyzed by calculating the area under the curve . Statistical analysis was performed with a mixed-model repeated- measures regression analysis for repeated measures of the various rating scales . Significant p values were < or = .05 . RESULTS Over the 12-month study period , VNS was associated with a 38.1 % mean improvement in overall illness as compared to baseline ( p = .012 ) , as well as significant reductions in symptoms as measured by the HAM-D-24 ( p = .043 ) , MADRS ( p = .003 ) , CGI ( p = .013 ) , and GAF ( p < .001 ) rating scales . Common adverse events were voice alteration during stimulation and hoarseness . CONCLUSION These data suggest that VNS may be an efficacious and well-tolerated treatment option for patients with treatment-resistant RCBD . Currently , no comparison is available in the literature . Larger r and omized trials are needed to verify these findings Objectives : To evaluate the effectiveness of repetitive transcranial magnetic stimulation ( rTMS ) started with citalopram in first-episode young major depressive patients . Methods : In a 2-week double-blind study with a 2-week extended antidepressant phase , 60 first-episode young major depressive patients were r and omly assigned to citalopram in combination with 2 weeks of either active or sham rTMS treatment . During the following 2 weeks , the patients continued only the citalopram treatment . The 17-item Hamilton depression rating scale ( HAMD-17 ) and Montgomery – Asberg depression rating scale ( MADRS ) were used to assess the severity of depression . Moreover , the Wisconsin Card Sorting Test ( WCST ) , Trail-Making Test ( TMT ) , and Stroop Color – Word Test ( SCWT ) were used to assess executive function . Results : ( 1 ) There was a significantly greater number of early improvers ( a reduction of HAMD-17 score ≥20 % within the first 2 weeks ) observed in the active rTMS group compared to the sham group ( 57 % vs. 29 % , χ2=4.667 , p=0.031 ) . ( 2 ) There was no significant difference observed in responder rates ( 46 % vs. 36 % , χ2=0.295 , p=0.586 ) or in remission rates ( 39 % vs. 29 % , χ2=0.319 , p=0.572 ) between the two groups at 4 weeks . ( 3 ) There was a significant difference seen in both HAMD-17 and MADRS scores between the two groups at 2 and 4 weeks . The active rTMS group showed a significantly faster score reduction compared to the sham group at 2 weeks ( HAMD-17 , t=13.444 , p=0.001 ; MADRS , t=30.123 , p=0.000 ) , which was maintained at 4 weeks on both scales ( HAMD-17 , t=46.915 , p=0.000 ; MADRS , t=39.996 , p=0.000 ) . ( 4 ) The patients did not deteriorate in executive performance , and even improved in categories on WCST and completed TMT faster in the active group . Conclusions : rTMS accelerated the rapidity of the antidepressant response in first-episode young depressive patients . Our results call for future rTMS studies with larger sample sizes , high intensity of stimuli , and longer duration to draw more definitive conclusions
Conclusions : According to the published literature , the clinimetric properties of HAM-D6 are superior to those of both the HAM-D17 and MADRS .
Background : In a study aim ed at identifying the items carrying information regarding the global severity of depression , the 6-item Hamilton Depression Rating Scale ( HAM-D6 ) was derived from the original 17-item version of the scale ( HAM-D17 ) .
Since then , the HAM-D6 has been used in a wide range of clinical studies .
We now provide a systematic review of the clinimetric properties of HAM-D6 in comparison with those of HAM-D17 and the Montgomery Asberg Depression Rating Scale ( MADRS ) .