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-Asberg Depression Rating Scale (MADRS) was explored in 684 major depressed patients (1114 observations). The value on the MADRS 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 MADRS. 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. (C) 2002 Elsevier Science B.V. All rights reserved.