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O ptimal management of major depressive disorders is enhanced by applying a chronic illnessmanagement model with precise and measurable therapeutic endpoints. 1 In contradistinction to several other chronic medical disorders, biological markers of illness activity in depression do not currently exist. In the interim, therapeutic progress is monitored by evaluating changes in the severity of depressive symptoms and in functional domains. This concatenation of findings is particularly disconcerting in view of the fact that most depressed patients in either primary care or psychiatric settings are not systematically evaluated with objective quantifiable measures -a modifiable deficiency in patient management. [2][3][4][5][6] The most frequently reported symptomatic outcome measure in clinical trials of antidepressants has been response to treatment, arbitrarily defined as a reduction of 50% or more in total symptom severity from a pretreatment assessment of the patient's depression. 7 A categorical response to therapy that fails to achieve a fully asympomatic remitted state furnishes an unsatisfactory outcome, in that it includes patients with ongoing disease activity that is clinically significant. Patients who show improvement in symptom severity but are not asymptomatic are at risk for developing chronic depression, and continue to be vulnerable to poor outcomes and comorbid medical disorders. [8][9][10] Remission is an objective outcome indicated by a quantifiable score with a depressive symptom measurement tool. In antidepressant clinical trials, the 17-item Hamilton Depression Rating Scale (HAMD-17) has been the "gold standard" for use. HAMD-17, however, has not been accepted by clinicians for many reasons, 11,12 notably psychometric deficiencies and the length of time needed to administer it.Although several brief rating scales for depression that attempt to improve upon the limitations of HAMD-17 have recently been validated and reviewed, [11][12][13][14][15][16][17][18] none that are brief, currently available and use a remission cut-off score that correlates with the most frequently cited definition of remission (a HAMD-17 score ≤ 7) 7 have been validated in both tertiary mental health and primary care settings.Our broad objective in using HAMD-7 was to improve upon the conceptual and pragmatic deficiencies ascribed to HAMD-17. HAMD-7 was originally derived from analyses of a natural practice database at a tertiary care centre composed of patients diagnosed with a major depressive disorder (n = 248). 14 The HAMD-17 items that were endorsed in a previous study 14 by 70% of depressed patients and were most sensi- Background: Symptomatic remission is the optimal outcome in depression. A brief, validated tool for symptom measurement that can indicate when remission has occurred in mental health and primary care settings is unavailable. We evaluated a 7-item abbreviated version (HAMD-7) of the 17-item Hamilton Depression Rating Scale (HAMD-17) in a randomized controlled clinical trial of patients with major de...

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