The GRID Hamilton Rating Scale for Depression (GRID-HAMD) is a modified version
of the popular depression rating scale developed by Max Hamilton in 1960. One difficulty
in administering earlier versions of the HAMD is that two important dimensions of
illness severity—intensity and frequency—must be taken into account when making
a single rating. However, there are no guidelines for the rater to help determine
the contribution of both to symptom severity. The GRID-HAMD was designed to permit
the rater to consider the dimensions of intensity and frequency independently for
each relevant item in the scale.
Symptom intensity is considered on the "vertical axis" and symptom frequency on
the "horizontal axis." Symptom intensity, which includes degree of symptom magnitude
as well as subjective distress and functional impairment, is rated as "absent, mild,
moderate, severe, and very severe." Symptom frequency is rated as "absent, occasional,
much of the time, and almost all of the time." Examples of degrees of intensity
and frequency are provided in the GRID itself.
The GRID-HAMD was designed to both simplify and standardize administration and scoring
in clinical practice and research. Item descriptions have been modified to enhance
the reliability of the scale and its relevance to depressed outpatients. The GRID-HAMD
includes a structured interview guide and set of rating conventions. Like many other
psychiatric semi-structured interviews, the GRID-HAMD is intended for use by individuals
who have received adequate training in the assessment of mood in a depressed population
and in the use of the GRID-HAMD itself.
Methods for characterizing the onset of treatment benefit in major depressive disorder
and generalized anxiety disorder have been studied for some time, yet there is no
uni- versal agreement as to the best approaches. Our purpose is to summarize the
conceptual framework underlying modern methods for characterizing onset and detailed
approaches for which there is consensus from the perspective of a clinician, clini-
cal researcher, and statistician. Possible alternatives to unresolved issues are
There were 17 experts from aca- demia, the pharmaceutical industry, and the US Food
and Drug Administration who met on April 19, 2007, to consider the issues. Many
others from sponsoring firms observed the proceedings.
A series of papers was presented at a consensus meeting and, after discussions,
a sense of the participants was obtained. A small group subsequently reviewed the
material and articles from the literature and prepared this article, which was reviewed
by all of the participants.
The elements that form the basis for describing onset of treatment benefit
include defining a clinical event or measurable threshold that validly signals that
a treatment has begun to provide clinically meaningful and sustained im- provement
and utilizing methods for estimating the probability of crossing the onset threshold,
the distribution of time to onset for those who do cross, and when to alter or change
interventions if the treatment is unsuccessful.
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