Hamilton Depression

We examined the data in a number of ways. One was to use the classification system established by the APA to categorize levels of depression. The APA system, which was also adopted by NICE, divides scores on the Hamilton depression scale into the following five categories ... 

How were the European regulators able to pull off the trick of turning a two-point difference on the Hamilton depression scale into a clinically significant benefit They did so by using a different criterion for improvement than the one we had used in our analysis of the clinical-trial data. We had analysed the average degree of improvement in symptoms that patients given antidepressants and... 

Winokur et al. (Winokur et al. 2000) found that mirtazapine significantly decreased sleep latency and increased total sleep time and sleep efficiency from baseline levels during week 1, with similar results observed after week 2. Mirtazapine did not significantly alter REM sleep parameters. Clinically, the Hamilton Depression Rating Scale and sleep disturbance ratings improved after treatment. 

Both enantiomers and the racemate of l-(3,4-dichlorophenyl)-3-azabicyclo [3.1.0]hexane, 27a-c, have been reported to be in development. The racemate, DOV 216,303, inhibits the reuptake of NE, 5-HT and DA with IC50 values of 20, 14 and 78 nM, respectively [85]. DOV 216,303 is active in tests predictive of antidepressant activity, including the mouse FST (minimum effective dose = lOmg/kg), reversal of tetrabenazine-induced ptosis and locomotor depression. DOV 216,303 was also reported to be well tolerated in phase I clinical trials [85,86], In a phase II study designed to explore safety and tolerability in depressed individuals, patients received either DOV 216,303 (50 mg, b.i.d.) or citalopram (20 mg, b.i.d.) for two weeks [85]. It was found that the side effect profile was not remarkably different between the two treatment groups. In addition, time-dependent reductions in Hamilton Depression Scores (HAM-D) were similar for both groups. 

Hamilton Depression Scale (HAMD) 12. Hopkin Symptom Checklist (HSCL) X X... 

Carroll Rating Scale for Depression. The Carroll Rating Scale for depression (52-item self-rating scale) is scored with yes or no answers by patients. It was designed to match closely the information content and specific items included in the Hamilton rating scale. It has been vahdated by comparisons with both the Hamilton Depression Scale (HAMD) and Beck and requires approximately 20 minutes to complete. Seventeen components of depression are measured. 

Hamilton Depression Scale. The HAMD is one of the most widely used tests to evaluate the severity of depressive illness quantitatively in adults. The most widely used form of this test contains 21 items covering a broad range of symptomatology, with a three- to five-point scale for most items. The minimum time required to complete this test is usually 10 to 20 minutes, and it requires a skilled interviewer. Either the present time or the period within the last week is rated. Six subscales are obtained in the HAMD anxiety/somatization, weight, cognitive disturbance, diurnal variation, retardation, and sleep disturbance. 

Other data arise as scores. These are frequently as a result of the need to provide a measure of some clinical condition such as depression or anxiety. The Hamilton Depression (HAM-D) scale and the Hamilton Anxiety (HAM-A) scale provide measures in these cases. These scales contain distinct items which are scored individually and then the total score is obtained as the sum of the individual scores. For the Hamilton Depression scale there are usually 17 items depressed mood, self-depreciation and guilt feelings, etc., each scored on a three-point scale or on a five-point scale. The five-point scales are typically scores 0 = absent, 1 = doubtful to mild, 2 = mild to moderate, 3 = moderate to severe and 4 = very severe while the three-point scales are typically 0 = absent, 1 = probable or mild and 3 = definite. 

The primary endpoint in this trial was the 17 point Hamilton Depression Scale (HAMD-17) and the data presented in Table 4.2 correspond to mean (se). 

So far, however, boundaries have not been established and, even worse, no systematic attempts to do so are noticed. This hampers biological psychiatry and may well be among the reasons that the search for biological markers of psychiatric disorders over the past 35 years has been remarkably unsuccessful. A concrete example may illustrate this point a score of at least 16-18 on the Hamilton Depression Scale (M. Hamilton 1960] is generally accepted as a criterion to include someone in a depression study. One could, however. 

Advances in Biological Psychiatry 17 58-69, 1988 Bech P Clinical properties of citalopram in comparison with other antidepressants a quantitative meta-analysis, in Citalopram The New Antidepressant from Lundbeck Research. Proceedings of a Symposium 11 August 1988. Edited by Montgomery SA. New York, Excerpta Medica, 1989, pp 56-68 Bech P, Bolwig TG, Kramp P, et al The Bech-Rafaelsen Mania Scale and the Hamilton Depression Scale. Acta Psychiatr Scand 59 420-430, 1979 Beck AT, Ward CH, Mendelson M, et al An inventory for measuring depression. Arch Gen Psychiatry 4 561-571, 1961... 

Bech, P., Bolwig, T.G., Kramp, P., et al . The Bech-Rafaelsen Mania Scale and the Hamilton Depression Scale. Acta Psyciuatr. Scand. 59(4), 420-430, 1979. 

Bech, P., Allerup, P., Reisby, N., et al Assessment of symptom change from improvement curves on the Hamilton Depression Scale in trials with antidepressants. Psychopharmacology (Berlin) 84, 276-281, 1984. 

Gibbons, R.D., Clark, D.C., Kupfer, D.J. Exactly what does the Hamilton Depression Rating Scale measure J. Psychiatr. Res. 27, 259-273, 1993. 

Williams, J.B.W. A structured interview guide for the Hamilton Depression Rating Scale. Arch. Gen. Psychiatry 45, 742-747, 1988. 

Throughout the rest of this chapter, response and remission rates are used. Therefore, these concepts are briefly discussed here. Response is most often defined as a 50% or greater reduction in symptom severity as measured by a standardized rating assessment such as the Hamilton Depression Rating Scale (HDRS). The drawback to this approach is that response does not differentiate between partial and complete response, particularly when the initial symptom severity is high. Thus, a patient could be classified as a responder and still be quite symptomatic. In some instances, a patient could be classified as responder and still meet entry requirements for an antidepressant clinical trial based on their persistent symptom severity. 

Augmentation with TMS in partially responsive, depressed patients has also been investigated. In one study of 24 major depressive disorder (MDD) patients, Conca et al. (212) compared an antidepressant plus LF-rTMS (<0.17 Hz, 1.9 T, 10 sessions) with an antidepressant only. Using the Hamilton Depression Rating Scale (HDRS) as the primary outcome measure, the authors reported that the combined treatment was superior to antidepressant monotherapy. 

Three terms beginning with the letter R are used to describe the improvement of a depressed patient after treatment with an antidepressant, namely response, remission, and recovery. The term response generally means that a depressed patient has experienced at least a 50% reduction in symptoms as assessed on a standard psychiatric rating scale such as the Hamilton Depression Rating Scale (Fig. 5—2). This also generally corresponds to a global clinical rating of the patient as much improved or very much improved. Remission, on the other hand, is the term used when essentially all symptoms go away, not just 50% of them (Fig. 5-3). The patient is not better the patient is actually well. If this lasts for 6 to 12 months, remission is then considered to be recovery (Fig. 5—3). 

Remission is defined as a Hamilton Depression Score less than 8 to 10 and a clinical global impression rating of normal, not mentally ill. 

Moritz S, Meier B, Hand I, Schick M, Jahn H (2004) Dimensional structure of the Hamilton Depression Rating Scale in patients with obsessive-compulsive disorder. Psychiatry Res 125 171-180... 

Angst, J., Scheidegger, P., Stabl, M. 1993, Efficacy of moclobemide in different patient groups. Results of new subscales of the Hamilton Depression Rating Scale, Clin.Neuropharmacol., vol. 16, suppl. 2, pp. S55-S62. 

In reality, since the short-term, company-run clinical trials were wholly unsuited to detecting suicidality, the risk had to be much more than modest to show up at all. In addition, Hammad et al. (2006) admitted to a fact that I had been insisting on for years in publications and testimony that the drug company s premier measure of suicidality, the Hamilton Depression (Ham-D) Scale, is useless in that regard. The investigator asks the subject questions from the scale, only one of which is related to suicidality. Obviously, the answers will depend on how seriously the question is asked, and rote questions are likely to elicit rote answers. The inventor of the Ham-D Scale did not himself believe that it could be used as a scientific tool in the manner that the drug companies have utilized it (Hamilton, 1960). 

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