Replacing Hamilton

The most popular method for monitoring depression is significantly flawed and needs replacement. So says R. Michael Bagby, clinical research director at the University of Toronto's Center for Addiction and Mental Health. Although the Hamilton Depression Rating Scale, developed in 1960, has long been a “gold standard” in psychiatric evaluation, Bagby says its shortcomings are well noted.

Bagby was the lead researcher of a metastudy that analyzed 70 independent research papers on the Hamilton scale's efficacy published since the last major review in 1979. The study was funded in part by Eli Lilly and the Ontario Mental Health Foundation.

Bagby says one of the scale's greatest problems is poor sensitivity to changes in a depressed individual's condition. This shortcoming makes it difficult to accurately monitor whether a patient is improving or declining and also confuses the approval of new antidepressant drugs, because the scale is a benchmark in judging their efficacy during clinical trials. Furthermore, the symptoms inventoried on the HAMD, as the scale is known, are simply out of step with modern research.

Although other scales have been introduced, none has achieved as widespread use as the Hamilton. In 1999 a cross-disciplinary team developed a revised version called the GRID-HAMD, but Bagby and his colleagues say that the entire concept needs to be retired.

Kenneth Evans, director of medical and scientific services at Axon Communications and a key developer of the GRID-HAMD, acknowledges that the metastudy's claims are valid. He is currently chair of the Depression Inventory Development Team, a collaborative effort among clinical researchers and representatives from 14 pharmaceutical companies that seeks to develop a new screening tool. Initial versions are currently being tested for efficacy.

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