Remission and Residual Symptomatology in Major Depression

Paykel, Eugene S.

doi:10.1159/000029018

Cited by 82 publications

(57 citation statements)

References 18 publications

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“…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.…”

mentioning

confidence: 99%

Measuring the severity of depression and remission in primary care: validation of the HAMD-7 scale

McIntyre

Konarski²,

Mancini³

et al. 2005

Canadian Medical Association Journal

111

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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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mentioning

confidence: 99%

Measuring the severity of depression and remission in primary care: validation of the HAMD-7 scale

McIntyre

Konarski²,

Mancini³

et al. 2005

Canadian Medical Association Journal

111

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“…However, the NCI, with medians of 72.0, 73.5 and 67.5 for each [25][26][27][28][29][30][31][32][33][34][35] different types. In unipolar depression, impairment when present affected attention and concentration, learning, and in some cases, executive function 23 .…”

Section: Discussionmentioning

confidence: 99%

Funciones cognitivas y terapia electroconvulsiva en pacientes psiquiátricos con enfermedad afectiva

Constaín

Saldarriaga

Rodríguez-Gásquez

et al. 2018

MedUPB

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Funciones cognitivas y terapia electroconvulsiva en pacientes psiquiátricos con enfermedad afectiva / Funções cognitivas e terapia eletroconvulsiva em pacientes psiquiátricos com doenças afetiva Gustavo A. Constaín 1 , María Victoria Ocampo Saldarriaga 2 , María de los Ángeles Rodrí-guez-Gásquez 3 , Julio César Restrepo Zapata 4 , David Monroy Duque 5 ABSTRACT Objective: Electroconvulsive therapy (ECT) has been considered a safe and effective treatment for depression, manic episodes, and other serious psychiatric conditions. Its main reported side effect has been cognitive impairment. This study describes the cognitive effects of ECT in psychiatric patients referred for treatment at a private clinic. Methodology: Descriptive case series study. A baseline assessment conducted before starting ECT, and another two (at one week and at six months) after completing the treatment cycle were used to describe the effects of frontotemporal bilateral ECT on neurocognitive function in terms of the change from the baseline to the final assessment in the domains of memory, psychomotor speed, reaction time, complex attention, and cognitive flexibility, as well as global cognitive function, as well as to determine ECT's safety by reporting adverse events. Cognitive assessment was conducted with a neuropsychological test battery and severity of psychiatric illness with the Clinical Global Impression-Severity scale (CGI-S). Six patients referred for treatment during six months were included. Results: No statistically significant differences were observed between the medians of the evaluations of CGI-S scale, global cognitive function or any of the domains evaluated. Conclusions: ECT did not produce changes in the cognitive functions assessed in the six studied patients. Keywords: electroconvulsive therapy; cognitive functions; adverse events; neuropsychological evaluation. RESUMENObjetivo: la terapia electroconvulsiva (TEC) se ha considerado un tratamiento seguro y eficaz para episodios de depresión mayor, para episodios maníacos y otros trastornos psiquiátricos serios. El estudio describe los efectos cognitivos de la TEC en pacientes referidos para tratamiento a una clínica privada. Metodología: estudio descriptivo del tipo de serie de casos. En cada participante se realizó una evaluación basal antes del inicio de la TEC y otras dos (una a la semana y otra a los seis meses) después de terminado el ciclo de tratamientos, para describir el efecto de la TEC frontotemporal bilateral en la función neurocognitiva mediante el cambio, desde el estado basal hasta la evaluación final en los dominios de memoria, velocidad psicomotora, tiempo de reacción, atención compleja y flexibilidad cognoscitiva, así como en la función cognoscitiva global; y determinar su seguridad por el reporte de eventos adversos. La evaluación cognitiva se realizó con una batería de pruebas neuropsicológicas y la severidad de la enfermedad psiquiátrica se evaluó con la escala Clinical Global Impression Severity (CGI-S). Se incluyeron seis pacientes remitidos para t...

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“…85,93,[133][134][135][136][137] In adult studies, patients who do not reach remission are more likely to have recurrent or chronic depression, suicidal ideation or behavior, and continuing impairment in work, relationships, and overall quality of life. [138][139][140][141][142][143][144][145][146][147][148] Similar evidence on the impact of nonremission is not available for youth.…”

Section: Rationale and Evidencementioning

confidence: 99%

“…• Guideline 34,35,48,49 • Quasi/nonexperimental [138][139][140][141][142][143][144][145][146][147][148] • RCT …”

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Evidence for the Management of Adolescent Depression

et al. 2013

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Adolescent depression is a prevalent and disabling condition resulting in emotional suffering and social and educational dysfunction. Care for adolescent depression is suboptimal and could be improved through the development and use of quality indicators (QIs). This article reports on the development of a care pathway and QIs for the primary and specialty care management of adolescent depression from case identification through symptom remission. It presents evidence from a review of adolescent clinical practice guidelines and research literature to support QIs at critical nodes in the pathway, and describes implications for practice based on existing evidence. Barriers to measure development are identified, including gaps in empirical evidence, and a research agenda is suggested. Pediatrics 2013;132:e996-e1009

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Remission and Residual Symptomatology in Major Depression

Cited by 82 publications

References 18 publications

Measuring the severity of depression and remission in primary care: validation of the HAMD-7 scale

Measuring the severity of depression and remission in primary care: validation of the HAMD-7 scale

Funciones cognitivas y terapia electroconvulsiva en pacientes psiquiátricos con enfermedad afectiva

Evidence for the Management of Adolescent Depression

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