Outcome in depression (II): Beyond the Hamilton Depression Rating Scale

Background 23 The Leuven Affect and Pleasure Scale (LAPS) was developed as an outcome measure in major 24 depressive disorder that better reflects patient treatment expectations. The present report 25 investigates whether the LAPS negative affect, the LAPS positive affect and the LAPS hedonic 26 tone have added value on top of the Hamilton Depression Rating Scale in explaining generic as 27 well as patient centered outcomes. 28 Key words: major depressive disorder, remission, interest, negative affect, pleasure, positive 29 affect 30 Methods 31 109 outpatients with DSM-5 major depressive disorder were assessed over 8 weeks of 32 antidepressant treatment. At baseline and after 2, 4 and 8 weeks, the LAPS, Hamilton Depression 33 Rating Scale (HAMD), Snaith Hamilton Pleasure Scale (SHAPS), Positive and Negative Affect 34 Scale (PANAS) and Sheehan Disability Scale (SDS) were administered. The Clinical Global 35 Impression of Improvement (CGI-I) and the PGI-I (Patient Global Impression of Improvement) 36 were also administered at endpoint. 37 Results 38 Changes in LAPS negative affect, LAPS positive affect and LAPS hedonic tone explain 14% of 39 the additional variance in CGI-I, 21% in PGI-I, 37% in cognitive functioning, 32% in overall 40 functioning, 31% in 'my life is meaningful' and 45% in 'I feel happy'. Compared to standard scales (PANAS, SHAPS), the LAPS negative affect, LAPS positive affect and LAPS hedonic 42 tone differentiate better between different levels of CGI-I or PGI-I. 43 Conclusions 44 The LAPS has added value (on top of the HAMD) in explaining changes in both generic 45 outcomes (CGI-I/PGI-I) and patient-centered dimensions. The LAPS negative and positive affect, 46 and the LAPS hedonic tone differentiate better CGI-I and PGI-I scores than corresponding scales 47 supposed to cover the same domains.