Differentiating moderate and severe depression using the Montgomery–Åsberg depression rating scale (MADRS)

Background: MADRS cut-off scores for moderate and severe depression were estimated in relation to the Hamilton Depression Rating Scale (HAMD17) and the Clinical Global Impressions Scale (CGI). Method: HAMD17, MADRS, and CGI ratings from patients with major depression (DSM-IV) were analyzed (N=85). Receiver operating characteristics (ROC) curves were applied. Results: Mean age was 51.4±14.5 years, 69% were female. Mean MADRS scores were 23.4±13.2, HAMD17, MADRS, and CGI scores were highly correlated (r>0.85; P<0.0001). Best separation between moderate and severe depression according to CGI criteria was achieved with a MADRS score of 31 (sensitivity 93.5%, specificity 83.3%). Limitations: Studies to validate severity gradations including DSM-IV or ICD-10 diagnostic severity categories are recommended. Conclusions: Empirically based MADRS cut-off scores to separate moderate from severe depression on the basis of HAMD17 and CGI severity ratings in patients with major depression were yielded.