The results from the JAMA paper (1, described in the last post) are reported using the Hamilton Depression Rating Scale. The scale is derived from a series of questions and scores are interpreted as follows:
- 0-7: Normal
- 8-13: Mild Depression
- 14-18: Moderate Depression
- 19-22: Severe Depression
- 23 or more: Very Severe Depression
Surprisingly, the benefit of anti-depressant medication (ADM), even for people with scores up to 22, was considered to be “less than … a standard definition of a small effect.” In another way of expressing the results, they found you would need to give ADM to 16 moderately depressed people in order for one of those 16 to have a better outcome than a similar patient taking a placebo (sugar pill). For those with severe depression this number was 11. A third way the results were reported was to look for patients who achieved the threshold for a meaningful response to ADMs as defined by the National Health Service (NHS) in England. The NHS definition is an improvement of 3 or more points on the Hamilton Scale. This was reliably met only by those who scored 25 or more before taking ADM, which means their depression was well into the Very Severe Range.
What does this mean for patients and clinicians? More in the next post.
1. Fournier JC et al. Antidepressant drug effects and depression severity: a patient-level meta-analysis. JAMA. 303(1):47-53, 2010 Jan 6.
Tags: depression
