A New Depression Scale Designed to be Sensitive to Change

1979 ◽  
Vol 134 (4) ◽  
pp. 382-389 ◽  
Author(s):  
Stuart A. Montgomery ◽  
Marie Åsberg
Keyword(s):  
Clinical Trials ◽  
Rating Scale ◽  
Antidepressant Treatment ◽  
Antidepressant Drugs ◽  
Depression Scale ◽  
Depressive Illness ◽  
Sensitivity To Change ◽  
Ethical Implications ◽  
Hamilton Rating Scale ◽  
Better Than

SummaryThe construction of a depression rating scale designed to be particularly sensitive to treatment effects is described. Ratings of 54 English and 52 Swedish patients on a 65 item comprehensive psychopathology scale were used to identify the 17 most commonly occurring symptoms in primary depressive illness in the combined sample.Ratings on these 17 items for 64 patients participating in studies of four different antidepressant drugs were used to create a depression scale consisting of the 10 items which showed the largest changes with treatment and the highest correlation to overall change.The inter-rater reliability of the new depression scale was high. Scores on the scale correlated significantly with scores on a standard rating scale for depression, the Hamilton Rating Scale (HRS), indicating its validity as a general severity estimate. Its capacity to differentiate between responders and non-responders to antidepressant treatment was better than the HRS, indicating greater sensitivity to change. The practical and ethical implications in terms of smaller sample sizes in clinical trials are discussed.

Clinical Features of Depression and the Response to Imipramine (“Tofranil”)

1962 ◽  
Vol 108 (452) ◽  
pp. 101-104 ◽  
Author(s):  
J. J. Fleminger ◽  
Bernard M. Groden
Keyword(s):  
Clinical Trials ◽  
Clinical Features ◽  
Antidepressant Drugs ◽  
Depressive Illness ◽  
Response To Treatment ◽  
Depressive State ◽  
Important Place ◽  
Depressed Patients ◽  
Better Than

Since it was first reported by Kuhn in 1957, the value of imipramine in the treatment of depressive illness has become generally recognized and confirmed by clinical trials (Blair, 1960; Daneman, 1961; Rees et al., 1961). It continues to hold an important place in therapy despite the introduction of many other antidepressant drugs and the occasional adverse report (Ashby & Collins 1961). Nevertheless the indications for its use are by no means established. It has been claimed that certain types of depression respond better than others: “psychotic” better than “neurotic” (Azima, 1959), “endogenous” better than “reactive” (Ball and Kiloh, 1959). Yet the difficulty of making these categorical distinctions, and of making reliable comparisons between the findings based upon them by different workers remains notorious. It is clear, however, that only a proportion of depressed patients respond well to imipramine. It is also certain that within the group which does respond well are to be found representatives of every type and degree of depressive state. There is evident need, therefore, for information that will help to indicate which characteristics of an individual will render him more or less susceptible to imipramine, and there does not appear to have been any study particularly devoted to this. In this paper we give the results of correlating certain clinical features of depression with the response to treatment by this drug.

Semi-structured Depression Scale Sensitive to Change with Treatment for Use in the Elderly

1994 ◽  
Vol 164 (4) ◽  
pp. 522-527 ◽  
Author(s):  
A. V. Ravindran ◽  
K. Welburn ◽  
J. R. M. Copeland
Keyword(s):  
Rating Scales ◽  
Rating Scale ◽  
Antidepressant Treatment ◽  
Depression Scale ◽  
The Elderly ◽  
Structured Interview ◽  
The Core ◽  
New Instrument ◽  
Before And After ◽  
Hamilton Rating Scale

The construction of a semi-structured interview depression scale that is sensitive to change for use in the elderly is described. Depression items from a well validated diagnostic instrument, the Geriatric Mental State Schedule (GMSS), were used as the core items in the development of the instrument. Improvement in depression in 80 elderly patients was independently assessed with two standard rating scales for depression, the Hamilton Rating Scale for Depression and the Beck Depression Inventory, and by an independent clinician's judgement before and after standard antidepressant treatment. Depression items that were sensitive to change were retained from the core items to form the new instrument. Results indicate that this scale is reliable and valid, shows better correlation with both the clinician's and the patient's judgement of improvement than the standard instruments, and is sparing of the rater's time.

What do Clinical Trials Tell us About Antidepressant Delayed Onset of Action?

2017 ◽  
Vol 41 (S1) ◽  
pp. S3-S4
Author(s):  
J. Rabinowitz
Keyword(s):  
Rating Scale ◽  
Antidepressant Treatment ◽  
Antidepressant Drugs ◽  
Depression Scale ◽  
Self Report ◽  
Symptom Improvement ◽  
Controlled Trials ◽  
Hamilton Depression Scale ◽  
Onset Of Action ◽  
Individual Patient Level

Response to antidepressants in major depressive disorder is highly variable and determinants are not well understood. Presentation will provide clinical trial data on time to response and determinants of response to antidepressant treatment. Data is from the Innovative Medicines Initiative funded NEWMEDS collaboration, a large public-private collaboration which assembled the largest dataset of individual patient level information from randomized placebo-controlled trials of antidepressant drugs. Studies were conducted by four large pharmaceutical companies. Dataset includes placebo-controlled trials of citalopram, duloxetine, escitalopram, quetiapine and sertraline in adults with MDD. We examined patient and trial-design-related determinants of outcome as measured by change on Hamilton Depression Scale or Montgomery–Asberg Depression Rating Scale in 34 placebo-controlled trials (drug, n = 8260; placebo, n = 3957). While it is conventional for trials to be 6–8 weeks long, data presented will show that drug-placebo differences were observable at week 4 with nearly the same sensitivity and lower dropout rates. Having any of these attributes was significantly associated with greater drug vs. placebo differences on symptom improvement: female, patients being middle aged, increasing proportion of patients on placebo, excluding all patients from centers with high placebo response regardless of active treatment response, using active run in periods and including self-report measures. Proof of concept trials can be shorter and efficiency improved by selecting enriched populations based on clinical and demographic variables, ensuring adequate balance of placebo patients, and carefully selecting and monitoring centers. In addition to improving drug discovery, patient exposure to placebo and experimental treatments can be reduced.Disclosure of interestI have received research grant(s) support and/or travel support and/or speaker fees and/or consultant fees from Takeda, Minerva, Intra-cellular Therapies, Janssen (J&J), Eli Lilly, Pfizer, BiolineRx, Roche, Abraham Pharmaceuticals, Pierre Fabre, Minerva and Amgen.

Treatment, outcome and predictors of response in elderly depressed in-patients

1997 ◽  
Vol 170 (5) ◽  
pp. 436-440 ◽  
Author(s):  
T. J. Heeren ◽  
P. Derksen ◽  
B. F. V. Heycop Ten Ham ◽  
P. P. J. Van Gent
Keyword(s):  
Clinical Trials ◽  
Treatment Outcome ◽  
Rating Scale ◽  
Antidepressant Treatment ◽  
Psychiatric Hospitals ◽  
The Elderly ◽  
Full Recovery ◽  
Treatment Expectations ◽  
Predictors Of Response ◽  
Vigorous Treatment

BackgroundFull recovery rates in naturalistic studies of the treatment of elderly depressives are invariably lower than in clinical trials. This may be the result of inadequate treatment due to the lack of clear treatment strategy recommendations for the elderly.MethodThis is a naturalistic prospective study of depressed elderly in-patients in three Dutch psychiatric hospitals. Patients were included when they suffered from any mood disorder according to DSM - III - R criteria. Severity of the depression was measured on the Montgomery -Asberg Rating Scale.ResultsAntidepressants were prescribed to more than 90% of the patients. More than half of them received only one treatment. The dose of the antidepressants was less than the recommended dose for adults in 55% of cases. Full recovery from the depressive episode was achieved in less than half of the patients (33–45%).ConclusionsIn the present study a relatively poor outcome of the antidepressant treatment of elderly depressives has been found. A combination of low treatment expectations and fear of vigorous treatment seems to have been important.

Placebo-Controlled Trial of Lithium Augmentation of Fluoxetine and Lofepramine

1995 ◽  
Vol 166 (1) ◽  
pp. 80-86 ◽  
Author(s):  
Cornelius L. E. Katona ◽  
Mohammed T. Abou-Saleh ◽  
Deborah A. Harrison ◽  
Bertrand A. Nairac ◽  
Denzil R. L. Edwards ◽  
...  
Keyword(s):  
Rating Scale ◽  
Antidepressant Treatment ◽  
Controlled Trial ◽  
Depressive Illness ◽  
Controlled Trials ◽  
Major Depressive ◽  
Double Blind ◽  
Primary Care Settings ◽  
Resistant Depression ◽  
Lithium Augmentation

BackgroundThis study was designed to establish whether (as suggested in a number of open and relatively small controlled trials) lithium augmentation is more effective than continued antidepressant alone, where response to a standard course of antidepressant treatment has been absent or partial.MethodLithium or placebo was added on a double-blind basis for six weeks to the drug regime of 62 patients with major depressive illness (in both hospital and primary care settings) who had failed to respond to a controlled trial of fluoxetine or lofepramine. Response was defined as a final Hamilton Depression Rating Scale (HDRS) score of < 10.ResultsResponse was seen more frequently in patients taking lithium (15/29) than in those remaining on antidepressant alone (8/32; P < 0.05). Rapid response to lithium augmentation (LA) was not consistently observed in this cohort. Mean HDRS scores after six weeks were significantly lower (P < 0.01) in the lithium group after excluding those who had not achieved significant exposure to lithium (arbitrarily defined as two or more lithium levels ≥ 0.4 mmol/1). No differences in the efficacy of LA were apparent between fluoxetine and lofepramine.ConclusionsOur results confirm that LA is a useful strategy in the treatment of antidepressant-resistant depression. Partial response was, however, frequently observed with continued antidepressant treatment alone, and the superiority of LA appears to depend on achieving adequate serum lithium levels.

Effects of ECT on Prolactin, LH, FSH and Testosterone in Males with Major Depressive Illness*

1989 ◽  
Vol 34 (8) ◽  
pp. 814-817 ◽  
Author(s):  
A.J. Cooper ◽  
R. Finlayson ◽  
V.R. Velamoor ◽  
R.V. Magnus ◽  
Z. Cernovsky
Keyword(s):  
Luteinizing Hormone ◽  
Sexual Functioning ◽  
Rating Scale ◽  
Follicle Stimulating Hormone ◽  
Depressive Illness ◽  
Serum Prolactin ◽  
Major Depressive ◽  
Treatment Changes ◽  
Severity Of Depression ◽  
Hamilton Rating Scale

Fourteen males with major depressive illness (DSM-III) received a course of electroconvulsive therapy (ECT). Serum prolactin (PRL), luteinizing hormone (LH), follicle stimulating hormone (FSH) and testosterone (T), were measured 15 minutes before and 15 minutes after each treatment. The severity of depression was assessed with the Hamilton Rating Scale for Depression (HRSD) two to three days before the first and two to three days following the last treatment. Post-ECT levels of PRL and LH were significantly higher than pre-ECT levels across every treatment. Changes in FSH and testosterone were not significant. There were no relationships between hormone levels (first versus last ECT) and severity of depression, including sexual functioning. It is argued that the relatively greater increases of LH than FSH is due to an acute antidopaminergic action of ECT which acts selectively on the secretion of the former. The blunted testosterone response to the increase of gonadotropins may be due to ECT-induced hyperprolactinemia.

scholarly journals Antidepressant drugs and sexual dysfunction

2013 ◽  
Vol 202 (6) ◽  
pp. 396-397 ◽  
Author(s):  
David S. Baldwin ◽  
Thomas Foong
Keyword(s):  
Depressive Symptoms ◽  
Sexual Dysfunction ◽  
Sexual Function ◽  
Antidepressant Treatment ◽  
Antidepressant Drugs ◽  
Self Esteem ◽  
Depressive Illness ◽  
Controlled Trials

SummaryDepressive symptoms and depressive illness are associated with impairments in sexual function and satisfaction but the findings of randomised placebo-controlled trials demonstrate that antidepressant drugs can be associated with the development or worsening of sexual dysfunction. Sexual difficulties during antidepressant treatment often resolve as depression lifts but may persist over long periods, and can reduce self-esteem and affect mood and relationships adversely. Sexual dysfunction during antidepressant treatment is typically associated with many possible causes, but the risk of dysfunction varies with differing antidepressants, and should be considered when selecting an antidepressant.

Brief Communication The movement of hostility during recovery from depression

1978 ◽  
Vol 8 (1) ◽  
pp. 145-149 ◽  
Author(s):  
G. C. Lyketsos ◽  
Ivy M. Blackburn ◽  
J. Tsiantis
Keyword(s):  
Rating Scale ◽  
Depressive Illness ◽  
Depression Score ◽  
National Norms ◽  
Hamilton Rating Scale ◽  
Over Time

SynopsisSixteen depressed in-patients from a hospital in Athens were assessed using the Hamilton Rating Scale and the Hostility and Direction of Hostility Questionnaire. Comparison of admission, discharge and mid-treatment scores showed that:(1) There was a larger drop in depression score in the first half of treatment.(2) Hostility scores, except for extrapunitiveness, decreased significantly over time, larger changes occurring in the first half of treatment.(3) Comparisons with British scores showed that during illness there were no significant differences between British and Greeks, though the latter tended to be more extrapunitive. At recovery, the Greeks were significantly more extrapunitive.The movement of hostility in depressive illness, the validity of the HDHQ and need for national norms are discussed.

Manic switch in bipolar patients treated with electroconvulsive therapy for treatment-resistant depression: The experience at the mood disorder unit of Milan (Italy)

2017 ◽  
Vol 41 (S1) ◽  
pp. S768-S768
Author(s):  
D. Delmonte ◽  
S. Brioschi ◽  
B. Barbini ◽  
R. Zanardi ◽  
C. Colombo
Keyword(s):  
Rating Scale ◽  
Remission Rate ◽  
Antidepressant Treatment ◽  
Age At Onset ◽  
Antidepressant Drugs ◽  
Mood Stabilizers ◽  
High Morbidity ◽  
Safe Procedure ◽  
Young Mania ◽  
Bipolar Patients

IntroductionDespite appropriate treatment, 30–40% of depressed patients, both unipolar and bipolar, do not achieve improvement, with high morbidity and mortality. For bipolar patients another risk is the switch into mania due to antidepressant treatment. The concern about the switch, suggests to administer antidepressants at lower doses, in combination with mood stabilizers and second generation anti-psychotics.ObjectivesWe performed an observational study on a sample of 23 bipolar patients treated with ECT for severe TRD in last 3 years, in order to evaluate the risk of switch.MethodsTwenty-three bipolar inpatients, undergoing bitemporal ECT twice/week, with MECTA spectrum device. Main demographic and clinical data collected. Hamilton rating scale for depression (HAM-D). Clinical response defined as 50% reduction of HAM-D score at the endpoint from baseline; remission as HAM-D score at the endpoint < 8. Young Mania rating scale (YMRS) weekly in order to assess switch into mania.ResultsThirteen (56.5%) females, 10 (43.5%) males, mean age 60.1 ± 10.3 years. Mean age at onset 35.5 ± 13.6 years. Mean number of episodes: 7.1 ± 3.6. Mean duration of current episode: 33.4 ± 24.9 weeks. Mean HAM-D basal score: 30.0 ± 5. Each patient underwent a cycle of ECT (mean No. 6.7 ± 3.3). Pharmacological treatment was administered upon clinical need. Response rate 87%, remission rate 43.5%. Three out of 23 (13.04%) patients had transient hypomanic switch, spontaneous recovery within 7 days after the last ECT.ConclusionsOur experience confirms that ECT is a powerful antidepressant, especially in patients with severe long-lasting depression, refractory to treatment. ECT is also a safe procedure: no adverse effects were reported. The manic switch rate is comparable with antidepressant drugs.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Studies of Depressive Symptoms in Schizophrenia

1981 ◽  
Vol 139 (2) ◽  
pp. 89-101 ◽  
Author(s):  
D. A. W. Johnson
Keyword(s):  
Depressive Symptoms ◽  
Rating Scale ◽  
Depressive Illness ◽  
Extrapyramidal Side Effects ◽  
Chronic Schizophrenics ◽  
Prevalence Of Depression ◽  
Depot Neuroleptic ◽  
Depot Injections ◽  
Higher Doses ◽  
Hamilton Rating Scale

SummaryDepression assessed by clinical examination and Hamilton rating scale was found in half of 37 untreated new acute schizophrenics, and in about a third of chronic schizophrenics who relapsed whether treated with depot injections (89) or not (79). A significant part of depressive illness in schizophrenics is thus not drug-related. However, depression was commoner in those on higher doses of depot neuroleptic (P <.05) or who showed extrapyramidal side effects (P <.001), suggesting that drugs can play a part. Patients maintained in remission on moderate doses of depot drug had the lowest prevalence of depression.

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