Hamilton Rating Scale for Depression

FUO Fever of unknown origin HRSD Hamilton Rating Scale for Depression... 

Finally, all of the trials in the FDA data set included the same measure of depression, a physician-rated scale called the Hamilton Rating Scale for Depression (HRSD). The Hamilton scale is completed by doctors based on interviews and observations of patients. The doctor rates the patient s mood, thoughts about suicide, sleep disturbances and other symptoms of depression. For example, one point is given if the patient feels that life is not worth living, and four points are scored if the person has made a serious suicide attempt. The result is a numerical score that can range from o to 51. 

FIGURE 6 4C. Graph showing that nimodipine (NIMOD) alleviates depressive symptoms as determined by two different scales [Hamilton Rating Scale for Depression [M. Hamilton 1960] and Beck Depression Inventory [Beck et al. 1961]) in a single patient. The number in each bar is the number of days during that phase of the study that were included in data analyses. FLAG = placebo ... 

Two later studies attempted to amend some of these deficiencies. One study by W. H. Nelson and colleagues [1984] used a double-blind randomized design to evaluate response in 13 patients with PMD and 12 patients with NPMD who received 150 mg of either imipramine or amitriptyline over a 4-week period. At the end of this trial, 2 of 13 patients with PMD had a Hamilton Rating Scale for Depression [M. Hamilton 1960] score of less than 8 [complete remission of symptoms], whereas 7 of 12 patients with NPMD had achieved remission. 

In a similar, but larger, double-blind study, 107 patients with unipolar and bipolar depression and 25 patients with PMD were randomly selected to either amitriptyline or imipramine after a 2-week placebo washout [Kocsis et al. 1990]. Doses of both drugs averaged >200 mg/day for 4 weeks. Approximately 67% of the moderately depressed patients with NPMD responded to pharmacotherapy, whereas only 32% of the patients with PMD experienced significant improvement with either drug. However, when severely depressed patients with NPMD [with Hamilton Rating Scale for Depression scores of >27] were compared with the patients with PMD, no difference in response rate was noted. 

To date, only one study has been completed with an antidepressant other than a TCA combined with an antipsychotic in the treatment of PMD. Rothschild and colleagues (1993) investigated the efficacy of fluoxetine and perphenazine in the treatment of PMD and found that approximately 73% of 30 patients who met DSM-III-R (American Psychiatric Association 1987) criteria for major depression with psychotic features had at least a 50% reduction on their Hamilton Rating Scale for Depression scores over 5 weeks. Furthermore, the combination of fluoxetine and perphenazine appeared to be better tolerated than the combination of TCAs with antipsychotics. Although there is no evidence that monotherapy with an antidepressant other than amoxapine is efficacious, the combination therapy with many antidepressants other than the TCAs may prove useful. 

Patient selection based on symptom severity. This can be defined directly by a minimal acceptable severity score as measured by a rating instrument (e.g. the Hamilton Rating Scale for Depression, the Positive and Negative Symptom Scale or other established assessment instruments see Section 5.6). An indirect definition of symptom severity may be a consequence of the status of a patient population a clinical trial designed for inpatients generally implies a more severe symptom profile than a study with... 

Another meta-analysis of placebo-controlled trials in depression published between 1980 and 2000 showed an increase in the response rates in the placebo arms of trials with a variety of antidepressants (Walsh et al.y 2002). Responses to placebo increased significantly in recent years, as shown by the high positive correlation with the year of publication. The association between response rate and year of publication was more statistically robust for placebo than for active medication. The change in placebo response rate did not appear to be explained directly by changes in study characteristics such as patient age, placebo lead-in or minimum required Hamilton Rating Scale for Depression score. A potential explanation could be the changing awareness of patients and the fact that many patients in recent clinical trials had been exposed to several previous treatments and thus expected to improve (see Box 5.4). 

The two most widely used scales for the measurement of severity of depression are the Hamilton Rating Scale for Depression (HRSD) and the... 

In a double-blind, parallel-group study, Bondareff et id. (2000) compared the SSRI sertraline and the tricyclic compound nortriptyline with regard to their efficacy and safety in a group of 210 outpatients 60 years and older. The patients met the DSM-DI-R criteria for major depressive episode and had a minimum score of 18 on the Hamilton Rating Scale for Depression. Their mean age was about 68 years, most patients were white and about 60% were female the severity of depression was rated as moderate in more than 70% and as severe in more than 20% of the cases. The daily doses of sertraline were between 50 and 150 mg, and those of nortriptyline were 25 100 mg the treatment lasted 12 weeks. In addition to clinical rating scales and self-assessment instruments, patients took the following tests of cognitive performance ... 

About 70% of the patients in both treatment groups completed the trial, with similar therapeutic efficacy (Hamilton Rating Scale for Depression) shown for both compounds. The pattern of adverse events was different, with more patients reporting diarrhea, nausea and insomnia on sertraline, and more patients on nortriptyline... 

In contrast a large trial of a naturally occurring biological compound called Substance P found no detectable difference from placebo. However the fact that substance P was associated with almost no side effects means that it was probably not distinguishable from an inert placebo. Paroxetine was used as the active comparator in these trials and the published paper suggests that its antidepressant effects were confirmed. In fact the difference between paroxetine and placebo was a miniscule 2-3 points on the Hamilton Rating Scale for Depression (Keller et al. 2006). 

Clinical trials invariably employ self-reporting of symptoms, using standardized questionnaires, the tool most often used being the 17-or 21-item Hamilton Rating Scale for Depression (HAM-D). A positive response to... 

DSM-TV-TR Diagnostic and Statistical Manual of Mental Disorders, 4th edition. Text Revision EPS extrapyramidal side effect GAP global assessment of functioning HAMD Hamilton Rating Scale for Depression IMC information-memory-concentration (test)... 

In all of these trials, the Hamilton Rating Scale for Depression (HAMD) [260], a well-validated and widely accepted observer rating scale for the assessment of the severity of depressive disorders, was employed as the primary outcome variable (if specified) or as the first of several outcome variables (if no distinction between primary and concomitant variables was made). As patients with psychotic features were excluded from most of the trials, the 17-item version was predominantly used. 

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