The cut-off points of the Depression and Somatic Symptoms Scale and the Hospital Anxiety and Depression Scale in detecting non-full remission and a current major depressive episode.

OBJECTIVE: This study aimed to ascertain the cut-off scores of the Depression and Somatic Symptoms Scale (DSSS) for non-full remission (FR) and a current major depressive episode (MDE) and compare the discriminative abilities of the DSSS and the Hospital Anxiety and Depression Scale (HADS). METHODS: One-hundred and nineteen depressive outpatients who completed a 6-month follow-up were used to ascertain the cut-off scores for non-FR, defined as a Hamilton Depression Rating Scale score ≥ 8; another 214 consecutive outpatients were assessed to identify the cut-off scores for a MDE, as defined by the Structured Clinical Interview for DSM-IV-TR. Receiver operating characteristic (ROC) analysis was used to ascertain the cut-off scores. RESULTS: The area under the ROC curve was greatest for the DSSS depression subscale (DS), followed by the HADS depression subscale (HADS-D). The cut-off scores for non-FR were a DS score ≥ 9 (sensitivity and specificity: 88.7 and 71.9%, respectively) and a HADS-D score ≥ 8 (77.4 and 84.2%), and the cut-off scores for a MDE were a DS score ≥ 19 (86.3 and 75.6%) and a HADS-D score ≥ 11 (77.9 and 76.5%). CONCLUSIONS: The DSSS and HADS can be used to distinguish different depressive states. The results demonstrated the discriminative validity of the DSSS and the HADS.

Effective treatment of premenstrual violence in major depression: augmentation with aripiprazole.

Premenstrual exacerbation of major depression is not uncommon. Premenstrual phase-related violence has also been reported. Serotonergic antidepressants, used both continuously and with increased dosage in the late luteal phase, are believed to be effective for major depressive disorder with premenstrual exacerbation. Adding a second medication for non-responder treatment is another treatment option. We present a 38-year-old woman suffering from major depression with premenstrual exacerbation of irritability and uncontrollable violence. The premenstrual exacerbation did not respond to increasing doses of selective serotonin reuptake inhibitor (SSRI) but a combination of an SSRI and late luteal phase aripiprazole was effective for her premenstrual violence. The serotonergic property of aripiprazole provides a synergic effect to SSRI for relieving premenstrual exacerbation of depression. The role of dopamine D2 as a partial agonist might further add to the effective alleviation of aggression and violence. An antidepressant with aripiprazole augmentation may be a treatment strategy for refractory premenstrual exacerbation and violence. Large-scale double blind placebo-controlled studies to verify efficacy are warranted.