A review of studies of the Montgomery-Asberg Depression Rating Scale in controls: implications for the definition of remission in treatment studies of depression

The Montgomery-Asberg Depression Rating Scale (MADRS) is one of the most commonly used symptom severity scales to evaluate the efficacy of antidepressant treatment Various cut-offs have been employed in antidepressant efficacy trials to define remission, although little empirical work has been carried out to determine the validity of various thresholds. One approach towards deriving a valid cut-off score for defining remission is to determine whether a patient's level of symptoms falls within the normal range of values after treatment. We therefore conducted a literature review of studies of the MADRS in healthy controls to determine the normal range of values. We identified 10 studies of 14 samples that included data on the MADRS for 569 controls. Across all studies, the mean (+/- SD) weighted MADIRS score, adjusting for sample size, was 4.0 (5.8) (95% confidence interval 3.5-4.5). These results are consistent with the findings of our study of the validity of different cut-offs to define remission on the MADRS-based on a narrow definition of remission, which required a complete absence of clinically significant symptoms of depression, the optimal MADRS cut-off was less than or equal to 4 whereas based on a broader definition, the optimal cut-off was less than or equal to 9. The findings can be used for normative comparisons in which post-treatment group mean scores are compared to mean scores from normative samples. A limitation of the review is that none of the studies was based on a randomly selected sample from the general population. In addition, the rigor of the screening used to exclude individuals with psychopathology in most studies is unknown; thus, some of the controls may have had diagnosable depression, thereby elevating the mean scores in the presumptively healthy control group. (C) 2004 Lippincott Williams Wilkins.