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BMC Psychiatry. 2018 Apr 11;18(1):100. doi: 10.1186/s12888-018-1679-x.

Standardisation framework for the Maudsley staging method for treatment resistance in depression.

Author information

1
Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia. abebaw.fekadu@aau.edu.et.
2
Global Health & Infection Department, Brighton and Sussex Medical School, University of Sussex, Brighton, UK. abebaw.fekadu@aau.edu.et.
3
King's College London, Institute of Psychiatry, Psychology and Neuroscience, Department of Psychological Medicine, Centre for Affective Disorders, London, UK. abebaw.fekadu@aau.edu.et.
4
King's College London, Institute of Psychiatry, Psychology and Neuroscience, Department of Psychological Medicine, Centre for Affective Disorders, London, UK.

Abstract

BACKGROUND:

Treatment-resistant depression (TRD) is a serious and relatively common clinical condition. Lack of consensus on defining and staging TRD remains one of the main barriers to understanding TRD and approaches to intervention. The Maudsley Staging Method (MSM) is the first multidimensional model developed to define and stage treatment-resistance in "unipolar depression". The model is being used increasingly in treatment and epidemiological studies of TRD and has the potential to support consensus. Yet, standardised methods for rating the MSM have not been described adequately. The aim of this report is to present standardised approaches for rating or completing the MSM.

METHOD:

Based on the initial development of the MSM and a narrative review of the literature, the developers of the MSM provide explicit guidance on how the three dimensions of the MSM--treatment failure, severity of depressive episode and duration of depressive episode-- may be rated.

RESULT:

The core dimension of the MSM, treatment failure, may be assessed using the Maudsley Treatment Inventory (MTI), a new method developed for the purposes of completing the MSM. The MTI consists of a relatively comprehensive list of medications with options for rating doses and provisions treatment for multiple episodes. The second dimension, severity of symptoms, may be assessed using simple instruments such as the Clinical Global Impression, the Psychiatric Status Rating or checklist from a standard diagnostic checklist. The standardisation also provides a simple rating scale for scoring the third dimension, duration of depressive episode.

CONCLUSION:

The approaches provided should have clinical and research utility in staging TRD. However, in proposing this model, we are fully cognisant that until the pathophysiology of depression is better understood, staging methods can only be tentative approximations. Future developments should attempt to incorporate other biological/ pathophysiological dimensions for staging.

KEYWORDS:

Depressive disorder; Remission; Staging; Maudsley staging method; Treatment-resistant depression

PMID:
29642877
PMCID:
PMC5896127
DOI:
10.1186/s12888-018-1679-x
[Indexed for MEDLINE]
Free PMC Article

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