Symptom differences between depressed outpatients who are in remission according to the Hamilton Depression Rating Scale who do and do not consider themselves to be in remission

Objective: Remission is usually defined as a score below a predetermined cutoff on a symptom severity scale. Depressed patients' global perception of their remission status only partially overlaps with scale-based definitions of remission. Patients' self-perceived remission status is likely to impact on their desire for modification in their treatment. The identification of specific symptoms that distinguish patients who do and do not consider themselves to be in remission could represent the most salient targets of add-on treatment strategies desired by patients. In the present report from the Rhode Island Methods to Improve Diagnostic Assessment and Services (MIDAS) project, we compared the symptom profiles of patients who were in remission on the Hamilton Rating Scale for Depression (HAMD) who did and did not consider themselves to be in remission. Methods: We interviewed 274 psychiatric outpatients diagnosed with DSM-IV major depressive disorder who were in ongoing treatment. The patients completed the Clinically Useful Depression Outcome Scale (CUDOS). Results: Approximately half of the patients scoring 7 and below on the HAMD did not consider themselves to be in remission. The mean number of symptoms on the CUDOS was significantly higher in the self-described non-remitters. Almost all symptoms were less frequent in the self-rated remitters, though the absolute frequency of the individual symptoms was related to the threshold used to define symptom presence. Discussion: Consistent with the findings of other studies we found high rates of residual symptoms in patients who were considered to be in remission, and patients with residual symptoms typically had more than 1 such symptom. These results raise questions about the strategy of add-on treatments targeting specific individual symptoms. Limitations: Remission was defined according to the 17-item version of the HAMD. We focused on the 17-item HAMD because it is the most commonly used measure in antidepressant efficacy trials, and the cutoff used to define remission has been generally accepted. We would anticipate that our findings would be similar in studies of longer versions of the HAMD as well as other depression severity scales such as the Montgomery-Asberg Depression Rating Scale. Self-perceived remission status was based on the patients' response to a single question. The sample was drawn from a single, large, general adult outpatient private practice setting in which the majority of the patients were white, female, and in their 30s and 40s. Generalizability to samples with different demographic characteristics needs to be demonstrated. (C) 2012 Elsevier B.V. All rights reserved.