Hostname: page-component-cb9f654ff-5jtmz Total loading time: 0 Render date: 2025-08-18T13:54:21.080Z Has data issue: false hasContentIssue false
  • English
  • Français

Outcome in depression (I): why symptomatic remission is not good enough

Published online by Cambridge University Press:  19 May 2020

Koen Demyttenaere ,
Glenn Kiekens ,
Ronny Bruffaerts ,
Philippe Mortier Open the ORCID record for Philippe Mortier [Opens in a new window] ,
Philip Gorwood ,
Lorcan Martin  and
Massimo Di Giannantonio
Koen Demyttenaere*
Affiliation:
Department of Neurosciences, University Psychiatric Center KU Leuven and Research Group Psychiatry, Faculty of Medicine, University of Leuven, Leuven, Belgium
Glenn Kiekens
Affiliation:
Department of Neurosciences, University Psychiatric Center KU Leuven and Research Group Psychiatry, Faculty of Medicine, University of Leuven, Leuven, Belgium
Ronny Bruffaerts
Affiliation:
Department of Neurosciences, University Psychiatric Center KU Leuven and Research Group Psychiatry, Faculty of Medicine, University of Leuven, Leuven, Belgium
Philippe Mortier
Affiliation:
IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
Philip Gorwood
Affiliation:
GHU Paris (CMME, Sainte-Anne hospital), Paris, France IPNP (INSERM U1266), Université de Paris, Paris, France
Lorcan Martin
Affiliation:
St. Loman’s Hospital, Mullingar, Co., Westmeath Ireland
Massimo Di Giannantonio
Affiliation:
Department of Neuroscience, Imaging and Clinical Sciences, “G. d’Annunzio” University, Chieti, Italy
*
*Koen Demyttenaere, Email: koen.demyttenaere@uzleuven.be
Get access Rights & Permissions [Opens in a new window]

Abstract

Background

The Leuven Affect and Pleasure Scale (LAPS) is a depression outcome measure aiming to better reflect patient treatment expectations. We investigated the evolution of the LAPS and some comparator scales during antidepressant treatment and compared scores of remitters with scores of healthy controls.

Methods

A total of 109 outpatients with Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5) major depressive disorder were assessed over 8 weeks of antidepressant treatment. At baseline and after 2, 4, and 8 weeks, the LAPS as well as the Hamilton Depression Rating Scale (HAMD), the Snaith–Hamilton Pleasure Scale (SHAPS), the Positive and Negative Affect Scale (PANAS), and the Sheehan Disability Scale (SDS) were administered. Healthy controls consisted of 38 Italian adults and 111 Belgian students.

Results

Correlations between baseline positive and negative affect were only moderate (R between −0.20 and −0.41). LAPS positive affect and hedonic tone showed higher correlations with LAPS cognitive functioning, overall functioning, meaningfulness of life, and happiness than HAMD scores or PANAS negative affect. HAMD remission was associated with normal levels of LAPS negative affect but with significantly lower levels of LAPS positive affect, hedonic tone, cognitive functioning, overall functioning, meaningfulness of life, and happiness. The scores on the latter subscales only reached healthy control scores when the HAMD approached a score of 0 or 1.

Conclusions

The standard definition of remission (HAMD cutoff of 7) is probably adequate for remitting negative mood, but not good enough for recovering positive mood, hedonic tone, functioning, or meaningfulness of life.

Keywords

Major depressive disorderremissioninterestnegative affectpleasurepositive affect.

Information

Type
Original Research
Information
CNS Spectrums , Volume 26 , Issue 4 , August 2021 , pp. 393 - 399
Copyright
© The Author(s), 2020. Published by Cambridge University Press

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.)

Article purchase

Temporarily unavailable

References

Hamilton, M. A rating scale for depression. J Neurol Psychiat. 1960;23:56–62.CrossRefGoogle ScholarPubMed
Montgomery, SA, Åsberg, M. A new depression rating scale designed to be sensitive to change. Br J Psychiatry. 1979;134:382–390.CrossRefGoogle ScholarPubMed
Åsberg, M, Montgomery, SA, Perris, C, Schalling, D, Sedvall, G. A Comprehensive Psychopathological Rating Scale. Acta Psychiatr Scand. 1978; 57 (suppl 271):5–27.CrossRefGoogle Scholar
Möller, HJ. Standardised rating scales in psychiatry: methodological basis, their possibilities and limitations and descriptions of important rating scales. World J Biol Psychiatry. 2009;10(1):6–26.CrossRefGoogle ScholarPubMed
Cuijpers, P, Li, J, Hofmann, SG, Andersson, G. Self-reported versus clinician-rated symptoms of depression as outcome measures in psychotherapy research on depression: a meta-analysis. Clin Psychol Rev. 2010;30:768–778.CrossRefGoogle ScholarPubMed
Fantino, B, Moore, N. The self-reported Montgomery-Åsberg depression rating scale is a useful evaluative tool in major depressive disorder. BMC Psychiatry. 2009;9:26. doi:10.1186/1471-244X-9-26.CrossRefGoogle ScholarPubMed
Zimmerman, M, McGlinchey, JB, Posternak, MA, Friedman, M, Attiullah, N, Boerescu, DA. How should remission from depression be defined? The depressed patient’s perspective. Am J Psychiatry. 2006;163(1):148–150.CrossRefGoogle ScholarPubMed
Demyttenaere, K, Donneau, AF, Albert, A, Ansseau, M, Constant, E, van Heeringen, K. What is important in being cured from depression? Discordance between physicians and patients (1). J Affect Disord. 2015;174:390–396.CrossRefGoogle Scholar
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5)Click here to enter text.. Washington, DC/London, UK: American Psychiatric Publishing; 2013.Google Scholar
Olson, TR, Presniak, MD, MacGregor, MW. Reevaluating positive affect in the Center for Epidemiologic Studies-Depression scale. Psychiatry Res. 2010;178:545–549.CrossRefGoogle ScholarPubMed
Demyttenaere, K, Mortier, P, Kiekens, G, Bruffaerts, R. Is there enough ‘interest in and pleasure in’ the concept of depression? The development of the Leuven Affect and Pleasure Scale (LAPS). CNS Spectr. 2019;24(2):265–274. doi:10.1017/S1092852917000578.CrossRefGoogle Scholar
Sheehan, DV, Harnett-Sheehan, K, Raj, BA. The measurement of disability. Int Clin Psychopharmacol. 1996;11(suppl 3):89–95.CrossRefGoogle ScholarPubMed
Watson, D, Clark, LA, Tellegen, A. Development and validation of brief measures of positive and negative affect: The PANAS Scales. J Personality Social Psychol. 1988;54(6):1063–1070.CrossRefGoogle ScholarPubMed
Snaith, RP, Hamilton, M, Morley, S, Humayan, A, Hargreaves, O, Trigwell, P. A scale for the assessment of hedonic tone: the Snaith-Hamilton Pleasure Scale. Br J Psychiatry. 1995;167:99–103.CrossRefGoogle ScholarPubMed
Guy, W. ECDEU Assessment Manual for Psychopharmacology – Revised (DHEW Publ. No. ADM 76–338). Rockville, MD: U.S. Department of Health, Education, and Welfare, Public Health Service, Alcohol, Drug Abuse, and Mental Health Administration, NIMH Psychopharmacology Research Branch, Division of Extramural Research Programs; 1976.Google Scholar
Chida, Y, Steptoe, A. Positive psychological well-being and mortality: a quantitative review of prospective observational studies. Psychosom Med. 2008;70:741–756.CrossRefGoogle ScholarPubMed
Yen, S, Weinstock, LM, Andover, MS, Sheets, ES, Selby, EA, Spirito, A. Prospective predictors of adolescent suicidality: 6-month post-hospitalization follow-up. Psychol Med. 2013;43:983–993.CrossRefGoogle ScholarPubMed
O’Connor, RC, Fraser, L, Whyte, MC, MacHale, S, Masterton, G. A comparison of specific future expectancies and global hopelessness as predictors of suicidal ideation in a prospective study of repeat self-harmers. J Affect Disord. 2008;110:2017–2214.Google Scholar
Winer, ES, Nadorff, MR, Ellis, TE, Allen, JG, Herrera, S, Salem, T. Anhedonia predicts suicidal ideation in a large psychiatric inpatient sample. Psychiatry Res. 2014;218:124–128.CrossRefGoogle Scholar
Uher, R, Perlis, RH, Henigsberg, N, et al. Depression symptom dimensions as predictors of antidepressant treatment outcome: replicable evidence for interest-activity symptoms. Psychol Med. 2012;42(5):967–980.CrossRefGoogle ScholarPubMed
Vinckier, F, Gourion, D, Mouchabac, S. Anhedonia predicts poor psychosocial functioning: results from a large cohort of patients treated for major depressive disorder by general practitioners. Eur Psychiatry. 2017;44:1–8.CrossRefGoogle ScholarPubMed
Cao, B, Park, C, Subramaniapillai, M, et al. The efficacy of vortioxetine on anhedonia in patients with major depressive disorder. Front Psychiatry. 2019;10:17. doi: 10.3389/fpsyt.2019.00017.CrossRefGoogle ScholarPubMed
Fredrickson, BL. The broaden-and-build theory of positive emotions. Phil Trans R Soc Lond. 2004;359:1367–1377.CrossRefGoogle ScholarPubMed
Frank, E, Prien, RF, Jarrett, RB, et al. Conceptualization and rationale for consensus definitions of terms in major depressive disorder. Arch Gen Psychiatry. 1991;48:851–855.CrossRefGoogle ScholarPubMed
Zimmerman, M, Martinez, J, Attiullah, N, et al. Further evidence that the cutoff to define remission on the 17-item Hamilton Depression Rating Scale should be lowered. Depression Anxiety. 2012;29:159–165.CrossRefGoogle ScholarPubMed