Rating depression over brief time intervals with the Hamilton Depression Rating Scale: Standard vs. abbreviated scales

Abstract

Although antidepressant trials typically use weekly ratings to examine changes in symptoms over six to 12 weeks, antidepressant treatments may improve symptoms more quickly. Thus, rating scales must be adapted to capture changes over shorter intervals. We examined the use of the 17-item Hamilton Depression Rating Scale (HDRS) to evaluate more rapid changes. Data were examined from 58 patients with major depressive disorder or bipolar disorder enrolled in double-blind, placebo-controlled, crossover studies who received a single infusion of ketamine (0.5 mg/kg) or placebo over 40 minutes then crossed over to the other condition. HDRS subscales, a single HDRS Depressed mood item, and a visual analog scale were used at baseline, after a brief interval (230 minutes), and one week post-infusion. Effect sizes for the ketamine-placebo difference were moderate (d>0.50), but one and two-item HDRS subscales had the smallest effects. Response rates on active drug were lowest for the complete HDRS (43%); the remaining scales had higher response rates to active drug, but the shortest subscales had higher response rates to placebo. Correlations between the changes from baseline to 230 minutes post-ketamine across scores were similar for most subscales (r=.82–.97), but correlations using the single items were lower (r<.74). Overall, effect sizes for drug-placebo differences and correlations between changes were lower for one- and two-item measures. Response rates were lower with the full HDRS scale. The data suggest that, to best identify rapid antidepressant effects, a scale should have more than two items, but fewer items than a full scale.

Assessing measures of suicidal ideation in clinical trials with a rapid-acting antidepressant

“…Moreover, the present study used several timeframes across the three days of assessment, which means that the assessment at the 230-minute time point is not directly comparable with the Day 3 time point. Similar analyses that lasted for seven days post-ketamine infusion also repeatedly assessed depressive symptoms (Luckenbaugh et al, 2014), although this time frame was not consistently available with the current dataset. Lastly, it is important to highlight that all suicidal thoughts were reported by the patient.…”

Self-Rated Health Status and Subjective Health Complaints Associated with Health-Promoting Lifestyles among Urban Chinese Women: A Cross-Sectional Study

“…Consistently, our results indicate that women performing poorly in stress management are at higher risk of symptom reporting, compared with those performing poorly in other categories of HPLP. Participants in stress management programs have been reported to display significantly fewer symptoms of depression, anxiety, stress, and improvement in sleep quality [ 43 ]. Thus, the importance of stress management programs, such as employing the services of stress consultants, should be highlighted among women in urban China.…”

The Hamilton Rating Scales for Depression: A Critical Review of Clinimetric Properties of Different Versions

“…Similarly, Liebowitz et al [124] found that the HAM-D 6 , but not the MADRS, detected the antidepressant superiority of desvenlafaxine over placebo. The sensitivity to change of the HAM-D 6 has been tested in a number of other clinical trials [121,123,[126][127][128][129][130][131][132].…”