Measuring Depression - Research Annual Report 2005

Michael Bagby: Finding better ways to measure depression

Clinicians in every field use questionnaires and forms to assess what problems a client has and how to measure the severity of these problems.

Since it was published in 1960, the Hamilton Rating Scale for Depression (Ham-D) has been the "gold standard" for assessing depression severity. It is also used by psychiatrists and other mental health professionals  to measure the effects of treatments for depression. Regulatory agencies in Canada, the United States and the European Union rely on the Ham-D to show that new antidepressant medications are effective before such medications are approved for public use.

This instrument is administered hundreds of thousands of times a year. Yet despite this wide-ranging use, many in the field have questioned the use of the Ham-D.

In the December 2004 issue of the American Journal of Psychiatry, Dr. R. Michael Bagby, a Senior Scientist and Psychologist  in the Mood and Anxiety Program and the Director of the Clinical Research Department at CAMH, reported on a systematic review he conducted of 70 studies of the Ham-D in the past 25 years, and concluded that the test was "psychometrically and conceptually flawed."

This article caused a great stir in the  academic and regulatory community, as its  findings have a direct impact on all aspects of how the effectiveness of depression treatments will be assessed and evaluated in future: both in measuring how well antidepressant medications work in clinical care and in developing new drugs for depression.

Dr. Bagby's article has been profiled in Psychiatric News, the official newspaper of American Psychiatric Association, and  he has been recently interviewed about his study by the editors of Scientific American.

His article prompted response from  the spokesperson of the Food and Drug Administration (which must approve all new medications in the United States) and the director of the American Psychiatric Association's Office of Research, Dr. Darrel Regier. Dr. Regier said, in Psychiatric News, that "Dr. Bagby's research has important implications for the future of DSM [the Diagnostic and Statistical Manual for Mental Disorders, used to diagnose depression] and how instruments like this should be considered."

When asked about his plans for future research in this area, Dr. Bagby says, "the next step is to develop and validate an alternative instrument to replace the Ham-D. My colleagues and I at CAMH have, in fact, constructed such a scale; we are now seeking to evaluate its validity and reliability. Perhaps we might actually call this scale the 'CAMH Depression Rating Scale'!"

"The next step is to develop and validate an alternative instrument to replace the Ham-D. My colleagues and I at CAMH have, in fact, constructed such a scale; we are now seeking to evaluate its validity and reliability. Perhaps we might actually call this scale the 'CAMH Depression Rating Scale'!" -Dr. Michael Bagby.

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