Profiles of antidepressant activity with the Montgomery-Asberg Depression Rating Scale

The Montgomery and Asberg Depression Rating Scale (MADRS) is a 10 item severity scale constructed to be sensitive to change with treatment. It was designed to be sensitive for individual items and is therefore useful for measuring differential profiles of action. The MADRS profiles of activity were examined in a six-week double-blind comparative group study of depressed patients treated with mianserin or zimeldine. Three of the ten items on the MADRS showed individual significant advantages for mianserin, reduced sleep (weeks 1 and 3), concentration difficulties (week 1), and reduced appetite (week 3). These findings are in agreement with earlier reports of poor sleep and gastrointestinal upset associated with the 5-HT uptake inhibitor zimeldine. The selective improvement in concentration difficulties and in the other items support the view that mianserin is particularly useful in alleviating the anxiety associated with depression. The sedative effect of mianserin did not appear to interfere with concentration. There were significant improvements in the mianserin-treated group at 1, 2, 3, and 4 weeks for the MADRS, Hamilton Depression Rating Scale and Clinicians Global Impression scale. There was no significant advantage for mianserin at 5 and 6 weeks. The differential clinical effects were apparent early in the study but any selectivity of action appeared to be overwhelmed by the general antidepressant effect later in treatment.