Outcome in depression (1): Why symptomatic remission is not good enough

Background.: The Leuven Affect and Pleasure Scale (LAPS) is a depression outcome measure aiming to better reflect patient treatment expectations. We investigated the evolution of the LAPS and some comparator scales during antidepressant treatment and compared scores of remitters with scores of healthy controls.Methods. A total of 109 outpatients with Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5) major depressive disorder were assessed over 8 weeks of antidepressant treatment. At baseline and after 2, 4, and 8 weeks, the LAPS as well as the Hamilton Depression Rating Scale (HAMD), the Snaith-Hamilton Pleasure Scale (SHAPS), the Positive and Negative Affect Scale (PANAS), and the Sheehan Disability Scale (SDS) were administered. Healthy controls consisted of 38 Italian adults and 111 Belgian students. Results.: Correlations between baseline positive and negative affect were only moderate (R between -0.20 and -0.41). LAPS positive affect and hedonic tone showed higher correlations with LAPS cognitive functioning, overall functioning, meaningfulness of life, and happiness than HAMD scores or PANAS negative affect. HAMD remission was associated with normal levels of LAPS negative affect but with significantly lower levels of LAPS positive affect, hedonic tone, cognitive functioning, overall functioning, meaningfulness of life, and happiness. The scores on the latter subscales only reached healthy control scores when the HAMD approached a score of 0 or 1. Conclusions.: The standard definition of remission (HAMD cutoff of 7) is probably adequate for remitting negative mood, but not good enough for recovering positive mood, hedonic tone, functioning, or meaningfulness of life.Affect Scale (PANAS) and the Sheehan Disability Scale (SDS) were 34 administered. Healthy controls consisted of 38 Italian adults and 111 Belgian students. 35 Results 36 Correlations between baseline positive and negative affect were only moderate (R between-.20 37 and-.41). LAPS positive affect and hedonic tone showed higher correlations with LAPS 38 cognitive functioning, overall functioning, meaningfulness of life and happiness than HAMD 39 scores or than PANAS negative affect. HAMD remission was associated with normal levels of 40 LAPS negative affect but with significantly lower levels of LAPS positive affect, hedonic tone, 41 cognitive functioning, overall functioning, meaningfulness of life and happiness. The scores on 42 the latter subscales only reached healthy control scores when the HAMD approached a score of 0 43 or 1. Conclusions 45 The standard definition of remission (HAMD cutoff of 7) is probably adequate for remitting 46 negative mood, but not good enough for recovering positive mood, hedonic tone, functioning or 47 meaningfulness of life.