Hostname: page-component-8448b6f56d-sxzjt Total loading time: 0 Render date: 2024-04-20T02:53:16.605Z Has data issue: false hasContentIssue false
  • English
  • Français

Melancholic symptoms as assessed by the Hamilton Depression Rating Scale and outcomes with and without electroconvulsive therapy on an in-patient mood disorders unit

Published online by Cambridge University Press:  24 June 2014

Keith G. Rasmussen ,
Susanna R. Stevens ,
Simon Kung  and
Amit Mohan
Keith G. Rasmussen*
Affiliation:
Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
Susanna R. Stevens
Affiliation:
Department of Biostatistics, Mayo Clinic, Rochester, MN, USA
Simon Kung
Affiliation:
Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
Amit Mohan
Affiliation:
Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
*
Keith G. Rasmussen, M.D., Department of Psychiatry and Psychology, Mayo Clinic, 200 First Street SW, Rochester, Minnesota 55905, USA. Tel: 507-284-3789; Fax: 507-284-4158; E-mail: rasmussen.keith@mayo.edu
Get access Rights & Permissions [Opens in a new window]

Abstract

Rasmussen KG, Stevens SR, Kung S, Mohan A. Melancholic symptoms as assessed by the Hamilton Depression Rating Scale and outcomes with and without electroconvulsive therapy on an in-patient mood disorders unit.

Background:

We investigated whether 24-item Hamilton Rating Scale for Depression (HamD24)-based melancholia ratings correlated with treatment outcome, with special focus on whether electroconvulsive therapy (ECT) was used in depressed patients treated on an in-patient mood disorders unit.

Methods:

We analysed the data on ECT- versus non-ECT-treated patients' outcomes relative to melancholia subscale scores. Two HamD24-based melancholia rating scale scores were computed for 201 depressed in-patients at admission and discharge. Baseline melancholia ratings were analysed to see if they correlated with improvement in total HamD24 scores. We also tested to see if the melancholia subscales followed unimodal or bimodal distributions.

Results:

Melancholic symptoms as assessed by one of the HamD24-based subscales directly correlated with overall improvement. Although ECT treatment was associated with greater improvement than was noted in non-ECT-treated patients, severity of melancholia ratings did not affect this relationship. Finally, both melancholia subscale scores followed approximately unimodal distributions.

Conclusions:

HamD24-based methods to assess severity of melancholic symptoms have limited clinical utility on an in-patient mood disorders unit in general, and for predicting ECT response in particular. Furthermore, these methods do not seem to identify bimodal populations of depressed patients (i.e. melancholic vs. non-melancholic).

Keywords

electroconvulsive therapymajor depressionmelancholiamood disorderstreatment
Type
Research Article
Information
Acta Neuropsychiatrica , Volume 22 , Issue 1 , February 2010 , pp. 21 - 25
Copyright
Copyright © 2009 John Wiley & Sons A/S

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Williams, JBW.Standardizing the Hamilton Depression Rating Scale: past, present, and future. Eur Arch Psychiatry Clin Neurosci 2001;251:(Suppl. 2):II/6–II/12. CrossRefGoogle ScholarPubMed
Thase, ME, Hersen, M, Bellack, AS, Himmelhoch, JM, Kupfer, DJ.Validation of a Hamilton subscale for endogenomorphic depression. J Affect Disord 1983;5:67–278. CrossRefGoogle Scholar
Kovacs, M, Rush, AJ, Beck, AT, Hollon, SD.Depressed outpatients treated with cognitive therapy or pharmacotherapy–a one-year follow-up. Arch Gen Psychiatry 1981;8:33–39. CrossRefGoogle Scholar
Endicott, J, Cohen, J, Nee, J, Fleiss, J, Sarantakos, S.Hamilton depression rating scale–extracted from regular and change versions of the schedule for affective disorders and schizophrenia. Arch Gen Psychiatry 1981;38: 98–103. CrossRefGoogle Scholar
Overall, JE, Rhoades, HM.Use of the Hamilton rating scale for classification of depressive disorders. Compr Psychiatry 1982;23:370–376. CrossRefGoogle ScholarPubMed
Klein, DF.Endogenomorphic depression–a conceptual and terminological revision. Arch Gen Psychiatry 1974;31: 447–454. CrossRefGoogle ScholarPubMed
Prudic, J, Devanand, DP, Sackeim, HA, Decina, P, Kerr, B.Relative response of endogenous and non-endogenous symptoms to electroconvulsive therapy. J Affect Disord. 1989;16:59–64. CrossRefGoogle ScholarPubMed
Spitzer, R, Endicott, J, Robins, E.Research diagnostic criteria. Arch Gen Psychiatry 1978;34:773–782. CrossRefGoogle Scholar
American Psychiatric Association. Diagnostic and statistical manual of mental disorders, 3rd edn. Washington, DC: American Psychiatric Association, 1980. Google ScholarPubMed
Taylor, MA, Fink, M.Melancholia: the diagnosis, pathophysiology, and treatment of depressive illness. Cambridge, UK: Cambridge University Press, 2006. CrossRefGoogle Scholar
American Psychiatric Association. Diagnostic and statistical manual of mental disorders, 4th edn–text revision. Washington DC: American Psychiatric Association, 2000. Google ScholarPubMed
Parker, G, Hadzi-Pavlovic, D, eds. Melancholia: a disorder of movement and mood. Cambridge UK: Cambridge University Press, 1996. CrossRefGoogle Scholar
Fink, M, Rush, AJ, Knapp, RG, et al. Melancholic features are unreliable predictors of ECT response. A CORE publication. J ECT 2007;23:139–146. CrossRefGoogle ScholarPubMed
First, MB, Spitzer, RL, Gibbon, M, Williams, JBW.Structured clinical interview for axis I DSM-IV disorders-patient edition (SCID-I/P, Version∼2.0). New York: Biometrics Research Department, New York State Psychiatric Institute, 1995. Google Scholar
Bailine, SH, Rifkin, A, Kayne, E, et al. Comparison of bifrontal and bitemporal ECT for major depression. Am J Psychiatry 2000;157:121–123. CrossRefGoogle ScholarPubMed
Sackeim, HA, Prudic, J, Devanand, DP, et al. Effects of stimulus intensity and electrode placement on the efficacy and cognitive effects of electroconvulsive therapy. N Engl J Med 1993;328:839–846. CrossRefGoogle ScholarPubMed