The Rothschild Scale for Antidepressant Tachyphylaxis: reliability and validity

After successful treatment of an episode of major depression, many patients complain of symptoms of apathy or decreased motivation (described by patients as "the blahs"), fatigue, dullness in cognitive function, sleep disturbance, weight gain, and sexual dysfunction; however, the characterization of this phenomenon of antidepressant tachyphylaxis has been hampered by the lack of an accepted definition and a reliable and valid assessment tool. To address this problem, the development and assessment of the Rothschild Scale for Antidepressant Tachyphylaxis (RSAT) are described.

The RSAT consists of 6 self-report items assessing energy level, motivation and interest, cognitive functioning, weight gain, sleep, and sexual functioning. A seventh item, affect, is assessed by the interviewer. Each item is measured within a 5-point ordinal scale with anchor points developed to illustrate each rating. This study assesses the internal consistency, test-retest reliability, convergent and discriminant validity, sensitivity, specificity, and positive and negative predictive values of the RSAT.

The RSAT demonstrated excellent internal consistency and scale reliability (Cronbach alpha = .902). The RSAT also demonstrated strong test-retest reliability (for depressed patients: r = 0.822, P < .01; for control subjects: r = 0.887, P < .01). The total RSAT score did not correlate with severity of depression as measured by the total Hamilton Depression Rating Scale score or the Hamilton Depression Rating Scale item 1 (depressed mood), supporting the discriminant validity of the RSAT for use in antidepressant tachyphylaxis.

The RSAT is a reliable measure of antidepressant tachyphylaxis.