Estimates of the minimal important difference to evaluate the clinical significance of antidepressants in the acute treatment of moderate-to-severe depression

Hengartner, Michael Pascal; Plöderl, Martin

doi:10.1136/bmjebm-2020-111600

Publication type:	Article in scientific journal
Type of review:	Peer review (publication)
Title:	Estimates of the minimal important difference to evaluate the clinical significance of antidepressants in the acute treatment of moderate-to-severe depression
Authors:	Hengartner, Michael Pascal Plöderl, Martin
et. al:	No
DOI:	10.1136/bmjebm-2020-111600
Published in:	BMJ Evidence-Based Medicine
Issue Date:	2021
Publisher / Ed. Institution:	BMJ Publishing Group
ISSN:	2515-446X 2515-4478
Language:	English
Subjects:	Clinical decision-making; Evidence-based practice; General practice; Health care quality; Health care access; Health care evaluation
Subject (DDC):	615: Pharmacology and therapeutics
Abstract:	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.
URI:	https://digitalcollection.zhaw.ch/handle/11475/22199
Fulltext version:	Published version
License (according to publishing contract):	Licence according to publishing contract
Departement:	Applied Psychology
Organisational Unit:	Psychological Institute (PI)
Appears in collections:	Publikationen Angewandte Psychologie

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Hengartner, M. P., & Plöderl, M. (2021). Estimates of the minimal important difference to evaluate the clinical significance of antidepressants in the acute treatment of moderate-to-severe depression. BMJ Evidence-Based Medicine. https://doi.org/10.1136/bmjebm-2020-111600

Hengartner, M.P. and Plöderl, M. (2021) ‘Estimates of the minimal important difference to evaluate the clinical significance of antidepressants in the acute treatment of moderate-to-severe depression’, BMJ Evidence-Based Medicine [Preprint]. Available at: https://doi.org/10.1136/bmjebm-2020-111600.

M. P. Hengartner and M. Plöderl, “Estimates of the minimal important difference to evaluate the clinical significance of antidepressants in the acute treatment of moderate-to-severe depression,” BMJ Evidence-Based Medicine, 2021, doi: 10.1136/bmjebm-2020-111600.

HENGARTNER, Michael Pascal und Martin PLÖDERL, 2021. Estimates of the minimal important difference to evaluate the clinical significance of antidepressants in the acute treatment of moderate-to-severe depression. BMJ Evidence-Based Medicine. 2021. DOI 10.1136/bmjebm-2020-111600

Hengartner, Michael Pascal, and Martin Plöderl. 2021. “Estimates of the Minimal Important Difference to Evaluate the Clinical Significance of Antidepressants in the Acute Treatment of Moderate-to-Severe Depression.” BMJ Evidence-Based Medicine. https://doi.org/10.1136/bmjebm-2020-111600.

Hengartner, Michael Pascal, and Martin Plöderl. “Estimates of the Minimal Important Difference to Evaluate the Clinical Significance of Antidepressants in the Acute Treatment of Moderate-to-Severe Depression.” BMJ Evidence-Based Medicine, 2021, https://doi.org/10.1136/bmjebm-2020-111600.