Maudsley Staging Method (MSM) for Treatment Resistant Depression (TRD)


This post will answer following three questions:

  1. How to use and score Maudsley Staging Method (MSM) for treatment resistant depression (TRD)? 

  2. What is the optimal cutoff score on MSM to differentiate TRD from non-TRD?

  3. Can MSM predict the outcome of ECT treatment in severely depressed adult patients?

 


Q.1: How to use and score Maudsley Staging Method (MSM) for treatment resistant depression (TRD)? 

 

Maudsley Staging Method is a multidimensional point based staging model based on following three factors:

 

(A) DURATION OF PRESENTING EPISODES:

  • ACUTE (<12 MONTHS) = 1 POINT.

  • SUB-ACUTE (13-24 MONTHS) = 2 POINT.

  • CHRONIC (>24 MONTHS) = 3 POINT.

 

(B) SEVERITY OF ILLNESS:

  • SUB-SYNDROMAL = 1 POINT.

  • MILD = 2 POINT.

  • MODERATE = 3 POINT.

  • SEVERE WITHOUT PSYCHOSIS = 4 POINT.

  • SEVERE WITH PSYCHOSIS = 5 POINT.

 

(C) TREATMENT TRIALS/FAILURES:

(C.1): ANTIDEPRESSANTS:

  • 1-2 MEDICATIONS = 1 POINT.

  • 3-4 MEDICATIONS = 2 POINT. 

  • 5-6 MEDICATIONS = 3 POINT. 

  • 7-10 MEDICATIONS = 4 POINT. 

  • >10 MEDICATIONS = 5 POINT. 

(C.2): AUGMENTATION:

  • NOT USED = 0 POINT.

  • USED = 1 POINT. 

(C.3): ECT:

  • NOT USED = 0 POINT.

  • USED = 1 POINT. 

 


 

Q.2: WHAT IS THE OPTIMAL CUTOFF SCORE ON MSM TO DIFFERENTIATE TRD FROM NON-TRD ?

 

ANS: 7.5

 


 

Q.3: CAN MSM PREDICT THE OUTCOME OF ECT TREATMENT IN SEVERELY DEPRESSED ADULT PATIENTS?

 

Linda van Diermen et al. conducted this study between August 2015 and August 2017:

  • N= 73 patients with major depression disorder undergoing ECT treatment. 

  • MSM done prior to each ECT treatment. 

  • Hamilton Depression Rating Scale (HDRS17) done at baseline and within 1 week of ECT treatment. 

 

RESULTS:

The percentage of symptom reduction following ECT was best predicted by following MSM factors:

 

(a) Episode duration:

  • Episode duration alone was the best predictor of remission.

  • Shorter episode duration is significantly associated with ECT effectiveness in adults. 

 

(b) Depression severity factors:

  • More severe depressive symptoms is significantly associated with ECT effectiveness in adults.

 

(c) Age:

  • Adding age to the models increased their predictive capacity.

  • older age is significantly associated with ECT effectiveness in adults. 

 


SOURCE:
  1. J Clin Psychiatry. 2009 Feb;70(2):177-84. Epub 2009 Jan 27.
  2. Defining and Differentiating Treatment-Resistant Depression: (https://utswmed-ir.tdl.org/handle/2152.5/1098).
  3. Acta Psychiatr Scand. 2018 Oct 1. PubMed PMID: 30270433.

Please do post your questions or comments below. 


Dr. Harvinder Singh, M.D. (Admin)


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