Comparison of Hamilton Depression Rating Scale and Montgomery-Åsberg Depression Rating Scale: Baked Straight From a Randomized Study

Abstract

Background and objectives: The symptoms of major depressive disorder (MDD) are nowadays being assessed with the Hamilton and Montgomery-Åsberg Depression Rating Scales. However, there are few studies on the comparison of these two scales. Our study aimed to determine the correlation between the Hamilton Depression Rating Scale (HDRS) and Montgomery-Åsberg Depression Rating Scale (MADRS) scores at baseline through 12 weeks.

Methods: An ongoing randomized, open-label, three-arm study's interim analysis is portrayed here. The participants were assessed with HDRS and MADRS at baseline, four, eight, and 12 weeks after receiving oral tablets of either vilazodone (20-40 mg/d), escitalopram (10-20 mg/d), or vortioxetine (5-20 mg/d). This study is prospectively registered with the Clinical Trial Registry, India (CTRI/2022/07/043808).

Results: Of 71 recruited individuals, 49 (69%) completed the 12-week visit. At baseline, the three groups' median HDRS scores were 30.0, 29.5, and 29.0 (p=0.76), and at 12 weeks, they reduced to 19.5, 19.5, and 18.0 (p=0.18). At baseline, the group-wise median MADRS scores were 36, 36, and 36 (p=0.79); at 12 weeks, they were 24, 24, and 23 (p=0.03). The Pearson correlation revealed that the association between the changes in scores from baseline was strongest for escitalopram (r=0.70, p=0.002) followed by vortioxetine (r=0.59, p=0.01) and vilazodone (r=0.59, p=0.02). The Bland-Altman analysis showed that the mean difference between the scores was 5.11 (95% CI: 3.08-7.14).

Conclusion: According to this interim study, HDRS and MADRS scores declined after 12 weeks of therapy. Both scores had strong positive correlation, and the difference between the scores reduced with time.

Keywords: beck’s depression inventory; bland-altman plot; correlation analysis; depressive disorder; escitalopram; hamilton depression rating scale; montgomery-asberg depression rating scale; serotonin receptor; vilazodone; vortioxetine.

Figure 1. The CONSORT diagram

The CONSORT (Consolidated Standards of Reporting Trials) diagram shows the screening, randomization, and completion of study visits till the interim analysis. Eleven patients were ineligible according to the study criteria. Ten were beyond 18-65, and one was 12 weeks pregnant at the baseline visit. This interim analysis was done in the per-protocol (PP) population (n = 49).

Figure 2. Baseline HDRS and MADRS scores of the study participants

The plots a, b, and c illustrate the correlation of baseline HDRS and MADRS scores of study participants from escitalopram, vilazodone, and vortioxetine groups, respectively. The jitter plots denote individual participants with their corresponding scores. The histograms on the X and Y axes represent the number of participants with their baseline HDRS and MADRS scores. The Pearson correlation was performed. HDRS_0: Baseline score according to Hamilton Depression Rating Scale; MADRS_0: Baseline score according to Montgomery-Åsberg Depression Rating Scale.

Figure 3. HDRS and MADRS scores of the study participants at 12 weeks

The plots a, b, and c illustrate the correlation of HDRS and MADRS scores of study participants from escitalopram, vilazodone, and vortioxetine groups, respectively, after 12 weeks of the interventions. The jitter plots denote individual participants with their corresponding scores. The histograms on the X and Y axes represent the number of participants with their HDRS and MADRS scores at 12 weeks. The Pearson correlation was performed. HDRS_12: Score at 12 weeks according to Hamilton Depression Rating Scale; MADRS_12: Score at 12 weeks according to Montgomery-Åsberg Depression Rating Scale.

Figure 4. Changes in HDRS and MADRS scores from baseline

The plots a, b, and c illustrate the correlation of changes in HDRS and MADRS scores of study participants from escitalopram, vilazodone, and vortioxetine groups, respectively at 12 weeks from their baseline values. The jitter plots denote individual participants with their corresponding scores. The histograms on the X and Y axes represent the number of participants with their difference in the HDRS and MADRS scores. The Pearson correlation was performed. Diff_H_12: Change in Hamilton Depression Rating Scale at week 12 from baseline; Diff_M_12: Change in Montgomery-Åsberg Depression Rating Scale at week 12 from baseline.

Figure 5. Bland-Altman plot for comparison of the two scales (HDRS and MADRS)

The Bland-Altman plot illustrates the comparison of HDRS and MADRS scores of all study participants at the baseline through week 12. The X and Y axes represent the mean and differences of both scores. The solid and dashed lines represent the mean difference and confidence intervals. HDRS: Hamilton Depression Rating Scale-17 items version; MADRS: Montgomery-Åsberg Depression Rating Scale.