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

Fekadu, Abebaw, Donocik, Jacek G and Cleare, Anthony J (2018) Standardisation framework for the Maudsley staging method for treatment resistance in depression. BMC Psychiatry, 18 (100). pp. 1-13. ISSN 1471-244X

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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.

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.

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.

Item Type: Article
Keywords: Depressive disorder, Treatment-resistant depression, Remission, Staging; Maudsley staging method
Schools and Departments: Brighton and Sussex Medical School > Global Health and Infection
Research Centres and Groups: Wellcome Trust Brighton and Sussex Centre for Global Health Research
Depositing User: Esther Garibay
Date Deposited: 14 May 2018 14:49
Last Modified: 14 May 2018 14:49

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