Study On The Indexes Of Clinical Cure Of Depression And Its Effectiveness

As the assessment of the efficacy of major depressive disorder (MDD) gradually standardized, more and more clinicians and researchers consider that MDD remission should describe not only a state of no or minimal symptoms but also restoration to normal functioning. The current cutoff of7on HAMD-17might be too high to define MDD remission.We interviewed318MDD responders with HAMD-17, Global Assessment of Functioning (GAF),177of them completed the generic quality of life inventory (GQOLI-74), and all patients were visited in a12-month follow-up. The study aims to1) to explore the residual symptoms and functional impairment of MDD patients who scored7or less on HAMD-17;2) using the ROC curve to explore the optimal cutoff on HAMD-17defining remission of MDD, and examine the validity of this cutoff point from aspects of symptom severity, functional level, and the relapse/recurrence rate. The results were lists below:1. After acute phase treatment for MDD, functional impairment was significantly associated with subsequent relapse/recurrence, with an odds ratio of2.87. even the HAMD-17scored7or less,51.0%of them also experienced functional impairment,78.8%did not restore to a premorbid state,91.9%of remitters had at least one subthreshold depressive symptoms, the most common were psychic anxiety (44.4%), sleep disturbance (52.5%), and general somatic symptoms (38.6%).2. When psychosocial functioning taken into account, a cutoff of≤3might be a more appropriate operational criterion of MDD remission. Compared to MDD patients scoring4-7on HAMD-17, patients scoring0-3had significantly better psychological functioning, social functioning and physical functioning(p<0.01), while no differences were found between patients scoring4-7and8-14; compared to4-7(16.5%) and8-14group (1.7%), the ratio that patients whose psychosocial functioning was normal among0-3group (75%) were higher (χ2=135.7, p<0.01), the ratio of restoration to a premorbid state was also higher (34.7%vs4.3%vs3.3%,χ2=50.5, p<0.01), and the relapse/recurrence rates were statistically different among0-3group (8.5%),4-7group (24.4%) and8-14group (35.6%)(χ2=18.02,p<0.01), suggesting that this operational criterion was valid.3. Patients scoring0-7on HAMD-17were heterogeneous. The0-3patients were similar with healthy controls, while4-7patients were similar with8-14group. Conclusions were listed as follows:1. After acute phase treatment for MDD, the functioning state could predict subsequent relapse/recurrence, while the residual symptoms relapse/recurrence. Even the HAMD-17scored7or less, most remitters have a few residual symptoms, and functional impairment.2. When taking functioning into account, a cutoff<3on HAMD-17may be a more appropriate operational criterion for remission of MDD. HAMD-17score drops0-3and4-7are different treatment outcomes. Symptomatic remission (HAMD-17≤7) is still the primary goal of the acute phase treatment. When maintenance phase begins, functional remission should be more valued.