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Defining remission by cut off score on the MADRS: selecting the optimal value
C J Hawley1, T M Gale, T Sivakumaran
1Department of Psychiatry, QEII Hospital, Hertfordshire AL7 4HQ, Welwyn Garden City, UK. c.l.hawley@herts.ac.uk
Background:
Remission from major depression may be conceptualised in terms of a cut-off score on an appropriate rating scale. Candidate values proposed hitherto have not been directly validated.
Method:
The relationship between The Clinical Global Impression Scale for Severity (CGI-S) and the Montgomery-Asberg Depression Rating Scale (MADRS) was explored in 684 major depressed patients (1114 observations). The value on the MADRS which had greatest concordance with remission, as defined by the CGI-S, was computed using two models. Concordance between clinician and patient judgements of global illness were also compared.
Results And Conclusion:
The two models yielded optimal definitions of remission of <9 and <10 on the MADRS. Either value offers a workable operationalisation of remission and there is little to choose between them.
Clinical Relevance:
The data confirm that MADRS <10 should provide the clinician with a valid, and reasonably objectifiable, target for remission
