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Differentiating moderate and severe depression using the Montgomery-Asberg depression rating scale (MADRS)
Matthias J Müller1, Hubertus Himmerich, Barbara Kienzle
1Department of Psychiatry, University of Mainz, Untere Zahlbacher Strasse 8, D-55131, Mainz, Germany. mjm@mail.psychiatrie.klinik.uni-mainz.de
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 validate 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.