Hengartner Michael P, Plöderl Martin
Department of Applied Psychology, Zurich University of Applied Sciences, Zurich, Switzerland
Department of Crisis Intervention and Suicide Prevention, Paracelsus Medical University Salzburg, Salzburg, Salzburg, Austria.
BMJ Evid Based Med. 2022 Apr;27(2):69-73. doi: 10.1136/bmjebm-2020-111600. Epub 2021 Feb 16.
The efficacy of antidepressants in the acute treatment of moderate-to-severe depression remains a controversial issue. The minimal important difference (MID) is relevant to judge the clinical significance of treatment effects. In this analysis paper, we discuss estimates of the MID for common depression outcome measures.For the Hamilton Depression Rating Scale 17-item Version (HDRS-17), according to both anchor-based and distribution-based approaches, MID estimates range from 3 to 8 points, and the most accurate values are likely between 3 and 5 points. For the 6-item version (HDRS-6), MID estimates range between 2 and 4 points. For both the Montgomery-Åsberg Depression Rating Scale (MADRS) and the Beck Depression Inventory II (BDI-II), MID estimates range between 3 and 9 points, with estimates of 3-6 points likely being the most accurate. Quality of life appears to be more important to patients than core depression symptoms. We thus also evaluated the Short-Form 36 (SF-36) mental component score, a popular mental-health-related quality of life measure. Its MID estimate is likely about 5 points. By contrast, the average treatment effects of antidepressants on the HDRS-17, HDRS-6, MADRS, BDI-II and SF-36 are 2 points, 1.5 points, 3 points, 2 points and 3-5 points, respectively.In conclusion, the efficacy of antidepressants in the acute treatment of moderate-to-severe depression consistently fails to exceed the lower bound of the MID estimates for common depression outcome measures. The clinical significance of antidepressants thus remains uncertain and we call for more research on quality of life measures, which are the patients' most valued outcome domains.
抗抑郁药在中重度抑郁症急性治疗中的疗效仍是一个有争议的问题。最小重要差异（MID）对于判断治疗效果的临床意义至关重要。在本分析论文中，我们讨论了常见抑郁症结局指标的MID估计值。对于汉密尔顿抑郁量表17项版本（HDRS - 17），根据基于锚定和基于分布的方法，MID估计值范围为3至8分，最准确的值可能在3至5分之间。对于6项版本（HDRS - 6），MID估计值范围在2至4分之间。对于蒙哥马利 - 阿斯伯格抑郁量表（MADRS）和贝克抑郁量表第二版（BDI - II），MID估计值范围在3至9分之间，3至6分的估计可能最准确。生活质量对患者似乎比核心抑郁症状更重要。因此，我们还评估了健康调查简表36（SF - 36）心理成分得分，这是一种常用的与心理健康相关的生活质量测量方法。其MID估计值可能约为5分。相比之下，抗抑郁药对HDRS - 17、HDRS - 6、MADRS、BDI - II和SF - 36的平均治疗效果分别为2分、1.5分、3分、2分和3 - 5分。总之，抗抑郁药在中重度抑郁症急性治疗中的疗效始终未超过常见抑郁症结局指标MID估计值的下限。因此，抗抑郁药的临床意义仍不确定，我们呼吁对生活质量测量方法进行更多研究，因为生活质量是患者最看重的结局领域。
