Defining remission by cut off score on the MADRS : selecting the optimal value

Background: Remission from major depression may be conceptualised in terms of a cut-off score on an appropriate rating scale. Candidate values proposed hitherto have not been directly validated. Method: The relationship between The Clinical Global Impression Scale for Severity (CGI-S) and the Montgomery–Åsberg Depression Rating Scale (MÅDRS) was explored in 684 major depressed patients (1114 observations). The value on the MÅDRS which had greatest concordance with remission, as defined by the CGI-S, was computed using two models. Concordance between clinician and patient judgements of global illness were also compared. Results and conclusion: The two models yielded optimal definitions of remission of <9 and <10 on the MÅDRS. Either value offers a workable operationalisation of remission and there is little to choose between them. Clinical relevance: The data confirm that MADRS <10 should provide the clinician with a valid, and reasonably objectifiable, target for remission.