Is the Cutoff to Define Remission on the Hamilton Rating Scale for Depression Too High?
Abstract
The Hamilton Rating Scale for Depression (HRSD) is the most frequently used measure of outcome in antidepressant efficacy trials. More than a decade ago, a consensus panel recommended that remission be defined on the 17-item version of the HRSD as a cutoff <or=7. This recommendation was accompanied by a call for research to validate this cutoff value; however, little research in this area has been performed since then. The goal of the present study was to compare the validity of different HRSD cutoffs for defining remission. Three hundred three depressed psychiatric outpatients were rated on the 17-item HRSD, the Global Assessment of Functioning (GAF) scale, and the Standardized Clinical Outcome Rating for Depression, an index of DSM-IV remission status. We examined the sensitivity, specificity, and overall classification rate of the HRSD for identifying a broad and narrow interpretation of the DSM-IV definition of remission, and the association between the breadth of the definition of remission on the HRSD and self-report ratings of global psychosocial functioning and quality of life. Based on a narrow definition of DSM-IV remission, which requires an absence of clinically significant symptoms of depression, the optimal 17-item HRSD cutoff was <or=2. Compared with patients scoring 3 through 7 on the HRSD, those who scored 0 to 2 reported significantly less psychosocial impairment and better quality of life. Our results thus support the use of a lower cutoff on the HRSD than…
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These two groups mentioned optimal asymptomatic thresholds for the HAMD-17 ranging from ≤2 to ≤10 and for the MADRS from ≤4 to ≤11.
“These two groups mentioned a variety of optimal asymptomatic thresholds for the HAMD-17 ranging from ⩽2 (Zimmerman et al. 2005) to ⩽10 (Zimmerman et al. 2004b) and for the MADRS ⩽4 (Zimmerman et al. 2004a, 2004d) to ⩽11 (Bandelow et al. 2006).”
From Empirical evidence for definitions of episode, remission, recovery, relapse and recurrence in depression: a systematic review (2019) · cites this paper as Zimmerman et al. 2005
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Frank, E. (1991) · Archives of General Psychiatry · doi:10.1001/archpsyc.1991.01810330075011 · Cited by 1,959 · cited 3× · see citing works
“Through the years, many cutoff scores have been used on the HRSD to define remission (Keller, 2003; Zimmerman et al., 1985); however, since the publication of the recommendations of Frank et al. (1991), a consensus has emerged to define remission on the HRSD as a score of 7 or less.”
BackgroundMethodResidual symptoms in depressed patients who respond acutely to fluoxetine
Nierenberg, A. A., Keefe, B. R., Leslie, V. C., Alpert, J. E., Pava, J. A., Worthington, J. J., Rosenbaum, J. F., & Fava, M. (1999) · The Journal of Clinical Psychiatry · doi:10.4088/jcp.v60n0403 · Cited by 470 · cited 1× · see citing works
“Nierenberg et al. (1999) reported that 10% of patients who were in remission according to their HRSD score ( 7) also met criteria for a depressive disorder, usually minor depression or subsyndromal depression (depressive disorder not otherwise specified, in DSM-IV terms), and one patient…”
BackgroundKeller, M. B. (2003) · JAMA · doi:10.1001/jama.289.23.3152 · Cited by 388 · see citing works
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Severity classification on the Hamilton depression rating scale
Zimmerman, M., Martinez, J. H., Young, D., Chelminski, I., & Dalrymple, K. (2013) · Journal of Affective Disorders · doi:10.1016/j.jad.2013.04.028 · Cited by 1,199 · see citing works
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Defining Response and Remission in Anxiety Disorders: Toward an Integrated Approach
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The Curious Neglect of High Functioning After Psychopathology: The Case of Depression
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McClintock, S. M., Haley, C., & Bernstein, I. H. (2011) · Neuropsychiatry · doi:10.2217/npy.11.59 · Cited by 7 · see citing works
- Authors
- Zimmerman, M., Posternak, M. A., & Chelminski, I.
- Affiliations
- Brown University (US)
- ORCID
- Zimmerman, Mark
- Venue
- Journal of Nervous & Mental Disease
- Published
- 2005-03
- Volume
- 193
- Issue
- 3
- Pages
- 170-175
- ISSN
- 0022-3018 (ISSN-L)
- OpenAlex
- W1975250091
- Cited by
- 79
- References
- 3
- Citations by year
- 2026: 2 · 2025: 1 · 2024: 2 · 2023: 3 · 2022: 2 · 2021: 3 · 2020: 2 · 2019: 3 · 2018: 6 · 2017: 1 · 2016: 5 · 2015: 2 · 2014: 7 · 2013: 3 · 2012: 6
- FWCI
- 3.21
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The Journal of Nervous and Mental Disease (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Pharmacology › Treatment of Major Depression
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Mental Health Research Topics
- Keywords
- Hamilton Depression Rating Scale, remission, cut-off values, antidepressant efficacy, sensitivity and specificity, psychosocial functioning, quality of life, Global Assessment of Functioning, SCORAD
- MeSH terms
- Adolescent, Adult, Aged, Ambulatory Care, Antidepressive Agents, Depressive Disorder, Female, Follow-Up Studies, Health Status, Humans, Male, Middle Aged, Terminology as Topic, Psychiatric Status Rating Scales, Psychometrics, Quality of Life, Surveys and Questionnaires, ROC Curve, Sensitivity and Specificity, Severity of Illness Index, Reproducibility of Results, Treatment Outcome, Diagnostic and Statistical Manual of Mental Disorders
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