With the DSM-IV symptoms of depression it is possible to create a profile of a patient by the score on agitation versus retardation, suicidal behavior, sleep problems, and weight loss versus weight gain. The only rating scales designed specifically to measure predictive validity of treatment by their total scores are the Newcastle Depression Scales (Newcastle 196510 and Newcastle 197111). With the introduction of DSM-III and DSM-IV, the

subdivision of depression into endogenous and reactive depression was deleted, and research on the Newcastle scales, Inhibitors,research,lifescience,medical which had been based on this concept, became very limited. The various guidelines on how to use the different antidepressants with reference to treatment-specific Inhibitors,research,lifescience,medical algorithms are typically based on the safety of the drugs and the patient-specific history of treatment resistance, rather than on the DSM-IV diagnosis of major depression or on a score on a depression rating scale.12 Research on how to uncover medication history to help with the treatment decision has been very limited. Posternak and

Zimmerman13 have recently examined Inhibitors,research,lifescience,medical how accurately patients can recall prior treatments with antidepressants. The results showed that approximately 80% remembered monotherapy correctly, while only 25% recalled augmentation therapy correctly. In the macroanalysis of the choice of treatment, it must therefore be concluded that rating scales with a factor profile such as Inhibitors,research,lifescience,medical the HAM-D seem to be superior to the DSM-IV diagnosis of major depression, but the DSM-IV depression symptoms individually can give important information about choice of treatment. However, when making decisions about individual patient-specific treatments, the tolerability of the antidepressant plays an important role, as does the history of previous outcome, especially in regard

to treatment resistance. Microanalysis According to Emmelkamp,2 the microanalysis of a depression rating scale is mainly focused on the clinimetric analysis of outcome measurements of treatment. This type of analysis, as discussed by Faravelli14 Inhibitors,research,lifescience,medical is based on certain assumptions which often involve pitfalls to such a degree that they can lead to “evidence-biased” rather than “evidence-based” psychiatry. The assumptions listed by Faravelli are: An illness is the whatever sum of its symptoms; The symptoms are represented by the numbers associated with specific behaviors; Operations conducted statistically on these numbers reflect actual changes in the clinical reality; The relationship among numbers is represented by simple additive selleck products effect, regardless of reciprocal interaction. These assumptions are the focus of the dialogue between Dr Gestalt and Dr Scales.1 One of the aspects discussed by Lam et al1 is that Dr Gestalt in his treatment may focus only on one symptom which might be misleading, while Dr Scales has a fuller picture of the patient’s current state.