What Is the Threshold for Symptomatic Response and Remission for Major Depressive Disorder, Panic Disorder, Social Anxiety Disorder, and Generalized Anxiety Disorder?
J Clin Psychiatry 2006;67(9):1428-1434
© Copyright 2015 Physicians Postgraduate Press, Inc.
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Objective: Symptom-free remission is a goal
for treatment in depression and anxiety disorders,
but there is no consensus regarding the threshold for
determining remission in individual disorders. We sought to determine these thresholds by comparing,
in a post hoc analysis, scores on the Clinical Global
Impressions scale (CGI) and disorder-specific
symptom severity rating scales from all available studies of
the treatment of major depressive disorder, panic
disorder, generalized anxiety disorder, and social
anxiety disorder with the same medication (escitalopram).
We also sought to compare the standardized effect
sizes of escitalopram for these 4 psychiatric disorders.
Data Sources and Study
Selection: Raw data from all randomized, double-blind,
placebo-controlled, acute treatment studies sponsored by
H. Lundbeck A/S (Copenhagen, Denmark) or Forest Laboratories, Inc. (New York, N.Y.),
published through March 1, 2004, with patients treated
with escitalopram for DSM-IV major depressive
disorder (5 studies), panic disorder (1 study), generalized
anxiety disorder (4 studies), or social anxiety disorder
(2 studies) were compared with regard to the
standardized effect sizes of change in CGI score and scores
on rating scales that represent the "gold standard"
for assessment of these disorders (the Montgomery-Asberg Depression Rating Scale, the Panic and
Agoraphobia Scale, the Hamilton Rating Scale for
Anxiety, and the Liebowitz Social Anxiety Scale, respectively).
Data Synthesis: In all indications, treatment
with escitalopram showed differences from placebo
in treatment effect from 0.32 to 0.59 on the CGI-S
and CGI-I and standardized effect sizes from 0.32 to
0.50 on the standard rating scales. There were no
significant differences among the different disorders.
Moderate to high correlations were found between
scores on the CGI and the standard scales. The
corresponding standard scale scores for CGI-defined
"response" and "remission" were determined.
Conclusion: Comparison of scores on the
standard scales and scores on the CGI suggest that the
traditional definition of response (i.e., a 50% reduction
in a standard scale) may be too conservative.