Measuring psychopathology by HAMD and CGI ratings to guide antidepressant treatment under naturalistic conditions

Abstract

Introduction: Clinical trials have shown that early improvement on the Hamilton Depression Rating (HAMD) scale is highly predictive for later response. The aim of this study was to find out if psychopathological rating using either the HAMD or Clinical Global Impression (CGI) scale is also predictive under every day conditions. Methods: Inpatients with a major depressive disorder were included and rated using the HAMD scale at baseline and on days 14 and 35 and by the CGI scale on day 14. On day 35, HAMD sum score reduction by at least 50% was defined as response. Results: 55 patients were included. An HAMD score reduction of ≥ 20% on day 14 was highly predictive (p = 0.01) for both response and non-response on day 35. HAMD sum scores correlated well on the CGI scale (p = 0.000). Patients with “much” or “minimal” improvement on the CGI scale on day 14 exhibited a more pronounced reduction on the HAMD scale on day 35 than patients who were “unchanged” or “worse” according to CGI (42 or 32% vs. 31 or 8%, respectively). CGI rating on day 14 predicted response on day 35 with only 44% specificity (p = 0.255). Regression analysis revealed that CGI explained only 5.1% of the variance of response on day 35 (chix2 = 1,5; df = 1; p = 0.209). Conclusion: From the findings that HAMD score changes from baseline to day 14 but not CGI scores on day 14 are predictive for later response it is concluded that HAMD but not CGI rating can be used under every day conditions to guide antidepressant pharmacotherapy.