Percentage reduction of depression severity versus absolute severity after initial weeks of treatment to predict final response or remission

Authors

  • Ching-Hua Lin MD, PhD,

    1. Kaohsiung Municipal Kai-Syuan Psychiatric Hospital, Kaohsiung, Taiwan
    2. Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
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  • Cheng-Chung Chen MD, PhD,

    1. Kaohsiung Municipal Kai-Syuan Psychiatric Hospital, Kaohsiung, Taiwan
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  • Fu-Chiang Wang MD,

    1. Kaohsiung Municipal Kai-Syuan Psychiatric Hospital, Kaohsiung, Taiwan
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  • Hsien-Yuan Lane MD, PhD

    Corresponding author
    1. Institute of Clinical Medical Science, China Medical University, Taichung, Taiwan
    2. Departments of Psychiatry, China Medical University Hospital, Taichung, Taiwan
    • Kaohsiung Municipal Kai-Syuan Psychiatric Hospital, Kaohsiung, Taiwan
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Correspondence: Hsien-Yuan Lane, MD, PhD, Department of Psychiatry, China Medical University Hospital (Taiwan), no. 2, Yuh-Der Road, Taichung City 404, Taiwan. Email: hylane@pchome.com.tw; hylane@gmail.com

Abstract

Aim

Percentage reduction of depression severity has been used to predict both response and remission of major depression. We aimed to compare the accuracy to predict response or remission by percentage reduction of depression score or depression score after initial weeks of treatment.

Methods

The subjects were 126 depressed inpatients who received 20 mg/day fluoxetine for 6 weeks. Symptom severity was assessed using the 17-item Hamilton Depression Rating Scale (HAMD-17). Response was defined as a reduction of 50% or more of the HAMD-17. Remission was defined as a score of ≤7 of the HAMD-17. At weeks 1, 2, 3 and 4, the percentages of HAMD-17 score reduction, the percentages of mood cluster score reduction, HAMD-17 scores, and mood cluster scores were regarded as potential predictors. The receiver operating characteristic curve was applied to determine the cut-off point of predictors at weeks 1, 2, 3, and 4.

Results

One-hundred and seven patients completed the 6-week trial. At weeks 1, 2, 3, and 4, percentages of HAMD-17 score reduction or HAMD-17 scores were the best predictors of responder or remitters, respectively. Using the percentage of HAMD-17 score reduction at each assessment as a predictor of response generated a larger area under the curve than other predictors. Conversely, applying the absolute HAMD-17 score at each assessment as a predictor of remission had the largest area under the curve.

Conclusion

Applying percentage of reduction in depression severity during the early weeks of treatment can predict response, and it is reasonable to apply depression severity to predict remission.

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