How to assess the onset of antidepressant effect: Comparison of global ratings and findings based on depression scales

The timing of clinical drug effects in depression can be estimated by a variety of methodological approaches, which might account for the heterogeneity of findings. We compared the patients' own ratings of the onset of antidepressant effect with onset estimations that were based on the intraindividual courses of depression as measured by the Hamilton Depression Rating Scale and a self-rating scale, the von Zerssen Adjective Mood Scale. The data of two control-group studies on brofaromine vs. imipramine were reanalyzed, the first, comprising 224 non-elderly and the second 195 elderly patients. In both studies the patients rated a significantly earlier onset of activity (means: days 12 and 16) than any other method. The means of the scale-based ratings varied between days 20 and 31 and showed a marked dependence on the response criteria selected: strict response criteria produced later onset estimations than less strict ones. Whereas the patient's own ratings indicated a significantly later onset of activity in the elderly patients, none of the scale-based measures supported this difference. The discussion focuses on the importance of methodological aspects.