Defining remission on the Montgomery-Asberg depression rating scale

In antidepressant efficacy trials, it is common to define treatment remission as a score below a cutoff on symptom severity measures. No consensus has emerged regarding an appropriate cutoff for defining remission on the Montgomery-Asberg Depression Rating Scale (MADRS). The goal of the present study was to establish an empirically based cutoff on the MADRS for defining remission.

303 psychiatric outpatients being treated for a DSM-IV major depressive episode were rated on the Standardized Clinical Outcome Rating for Depression, an index of DSM-IV remission status; the MADRS; and the Global Assessment of Functioning (GAF) scale. We examined the sensitivity, specificity, and overall classification rate of the MADRS for identifying a broad and narrow interpretation of the DSM-IV definition of remission, as well as the association between the breadth of the definition of remission and psychosocial functioning.

On the basis of a narrow definition of remission, which requires a complete absence of clinically significant symptoms of depression, the optimal MADRS cutoff was < or = 4. On the basis of a broader definition, the optimal cutoff was < or = 9. Compared with patients scoring 5 through 9 on the MADRS, those who met the narrow definition of remission were rated higher, indicating better functioning, on the GAF and reported significantly less psychosocial impairment (p <.05).

Our results support the use of a low cutoff on the MADRS to define remission. Because the choice of cutoff will impact the percentage of patients who are considered to be in remission and thus impact conclusions about treatment effectiveness, more empirical study should be directed toward this issue.