Early improvement in HAMD-17 and HAMD-6 scores predicts ultimate response and remission for depressed patients treated with fluoxetine or ECT

Abstract

Background HAMD-6 is derived from the 17-item Hamilton Rating Scale for Depression (HAMD-17).We explore whether HAMD-6 is a reliable, valid, and sensitive to change measure, and whether early improvement using HAMD-6 can predict ultimate response/remission for inpatients with major depressive disorder (MDD) receiving either fluoxetine or electroconvulsive therapy (ECT).Methods Data were from 2 trials for 126 MDD inpatients receiving fluoxetine, and 116 inpatients receiving ECT. Internal consistency, validity, and sensitivity to change using HAMD-17 and HAMD-6 at each assessment were examined and compared. Early improvement was defined as an at least 20% reduction of HAMD-17 or HAMD-6 scores at week 2 for patients receiving fluoxetine, or after 6 treatments for patients receiving ECT. Response was defined as ≥ 50% HAMD-17 score improvement from baseline, and remission was defined as a total HAMD-17 score of ≤ 7 at endpoint. Receiver operating characteristic analysis was used to determine which rating scale had better discriminative capacity.Results HAMD-6 is a reliable, valid, and sensitive to change measure. Early improvement using HAMD-6 had comparable predictive values with that of HAMD-17 for response/remission for patients receiving either fluoxetine or ECT.Limitations Samples were taken from 2 open-label trials with limited sample sizes.Conclusions HAMD-6 is a clinically useful measure. Those patients without early improvement, however, have a minimal chance of reaching ultimate response/remission, regardless of whether HAMD-17 or HAMD-6 was use.