Sensitivity to changes during antidepressant treatment: a comparison of unidimensional subscales of the Inventory of Depressive Symptomatology (IDS-C) and the Hamilton Depression Rating Scale (HAMD) in patients with mild major, minor or subsyndromal depression

Abstract

In the efficacy evaluation of antidepressant treatments, the total score of the Hamilton Depression Rating Scale (HAMD) is still regarded as the 'gold standard'. We previously had shown that the Inventory of Depressive Symptomatology (IDS) was more sensitive to detect depressive symptom changes than the HAMD17 (Helmreich et al. 2011). Furthermore, studies suggest that the unidimensional subscales of the HAMD, which capture the core depressive symptoms, outperform the full HAMD regarding the detection of antidepressant treatment effects. The aim of the present study was to compare several unidimensional subscales of the HAMD and the IDS regarding their sensitivity to changes in depression symptoms in a sample of patients with mild major, minor or subsyndromal depression (MIND). Biweekly IDS-C28 and HAMD17 data from 287 patients of a 10-week randomised, placebo-controlled trial comparing the effectiveness of sertraline and cognitive-behavioural group therapy in patients with MIND were converted to subscale scores and analysed during the antidepressant treatment course. We investigated sensitivity to depressive change for all scales from assessment-to-assessment, in relation to depression severity level and placebo-verum differences. The subscales performed similarly during the treatment course, with slight advantages for some subscales in detecting treatment effects depending on the treatment modality and on the items included. Most changes in depressive symptomatology were detected by the IDS short scale, but regarding the effect sizes, it performed worse than most subscales. Unidimensional subscales are a time- and cost-saving option in judging drug therapy outcomes, especially in antidepressant treatment efficacy studies. However, subscales do not cover all facets of depression (e.g. atypical symptoms, sleep disturbances), which might be important for comprehensively understanding the nature of the disease depression. Therefore, the cost-to-benefit ratio must be carefully assessed in the decision for using unidimensional subscales.

A Systematic Review of the Clinimetric Properties of the 6-Item Version of the Hamilton Depression Rating Scale (HAM-D₆)

“…For sertraline 200 mg, the effect size was 0.38 on HAM-D 6 and 0.20 on HAM-D 17 . In the placebo-controlled sertraline study by Helmreich et al [37], only the effect size for HAM-D 6 was shown, namely 0.46. In the study by Martiny et al [38], focusing on adjunctive bright light to sertraline in non-seasonal major depression, the effect size was 0.66 on HAM-D 6 and 0.45 on HAM-D 17 .…”

Trichotillomania: the impact of treatment history on the outcome of an Internet-based intervention

“…Depressive symptoms have been shown consistently to be associated with cognitive impairments,53 and these symptoms could impair learning and the application of new adaptive behaviors. However, the severity level of depression in both samples was relatively low and did not reach diagnostic thresholds for a current depressive episode in most individuals 54. This might explain why potential cognitive effects of depression did not affect treatment outcome in this study.…”

Blended care vs. usual care in the treatment of depressive symptoms and disorders in general practice [BLENDING]: study protocol of a non-inferiority randomized trial

“…This scale has been widely used in clinical trials and serves as gold standard for assessment of depression. It has been found valid and reliable measurement outcome with a higher inter-rater reliability and test-retest reliability [59, 61]. …”