The Skinny On Scales

[clement]

Is there a HAM-D equivalent as far as "gold standard scales" when it comes to Bipolar Disorder? So far I get the impression (from research article methods) that it is common to use separate scales for depression and for mania (like HAM-D + Young Mania) rather than separate scales for Bipolar I and II.

Also, is HAM-D still valid for treatment resistant depression and what the heck distinguishes resistance from having no depression, if that is the case?

Thanks in advance for contributing to my psych rotation.

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[erg923]

Both of those scales are primarily used in research and no one i know has ever given them clinically. If your looking to quantify change over time during your clinical treatment, the Beck would be much better and easier. An yes, the Young scale is most common in bipolar. The HAM has no mania questions (althoug some that would senstive to it) so mania necessitates another questioniares, like the Young.

Im not sure i underatnd that second part of the question, but yes we have used the HAM here in studies of Tx resistant depression.

PS: I have a factor analysis article in-press on the HAM, and the overall, my review is not very favorable. Bagby (2004) alos hads a had a good review article of the psychometic properties that is pretty scathing.

 

[clement]

Both of those scales are primarily used in research and no one i know has ever given them clinically. If your looking to quantify change over time during your clinical treatment, the Beck would be much better and easier. An yes, the Young scale is most common in bipolar. The HAM has no mania questions (althoug some that would senstive to it) so mania necessitates another questioniares, like the Young.

Im not sure i underatnd that second part of the question, but yes we have used the HAM here in studies of Tx resistant depression.

PS: I have a factor analysis article in-press on the HAM, and the overall, my review is not very favorable. Bagby (2004) alos hads a had a good review article of the psychometic properties that is pretty scathing.

Thanks...For the second question, I was wondering what distinguishes 0 depression from TRD in the context of "milder depression" after medication rather than no depression. I guess a better way to put it is, what defines treatment resistant depression? Unchanged depression or depression that has improved but only slightly? How many points on the HAM-D make the distinction, if at all?

 

[erg923]

Well the definition or tx-resistant depression has nothing to do with the HAM. Tx resistant depression is defined as depression that does not respond to adequate courses of least 2 antidepressants. How the term "adaquate" is defined is up for debate.

I dont think think there is unnanomously agreeed upon research based criteria for defining the "adaquate" in tx resistant depression, is there? Im not sure.

 

[clement]

Well the definition or tx-resistant depression has nothing to do with the HAM. Tx resistant depression is defined as depression that does not respond to adequate courses of least 2 antidepressants. How the term "adaquate" is defined is up for debate.

I dont think think there is unnanomously agreeed upon research based criteria for defining the "adaquate" in tx resistant depression, is there? Im not sure.

Regarding the topic of SSRI's and suicidal ideation, would it be fair to categorize that as a form of tx resistance? The thing is, I'm not sure how we'd view it in terms of SSRI's inherently causing the ideation or their failure in tx of the depression as causing the ideation.

 

[erg923]

The most common explantion is that the increase in energy that people get within the first weeks of taking SSRIs gives them the motivation and energy to actually carry out the plan.

 

[kugel]

The most common explantion is that the increase in energy that people get within the first weeks of taking SSRIs gives them the motivation and energy to actually carry out the plan.

That explanation never really held up well to me. I feel like it's a bit of an old wives' tale. I think it is much more likely that one of the following is true:

A) it is a myth. there is no increase in suicidal behavior related to initiation of antidepressants (BTW, this idea has been around longer than SSRI's). It's just that those most likely to get an Rx are those most likely to have SI in the near future, i.e. the sicker the patient the more likely to get an Rx and also the more likely to get SI.

B) it is a product of placebo effect running out before the medicine takes effect. If you felt better in just 1-2 days, but then that feeling faded in 5-7 days, you'd feel even worse because it would seem that you've now been abandoned by the medicine, too!

C) Treatment provides an opening and a "safe zone" to talk about SI that has been there already.

Just my thoughts