RATING ANTIDEPRESSANT EFFICACY WITH NATURALISTIC LIVE VERSUS STRUCTURED VIDEOTAPED INTERVIEWS

Two different methods were compared in the assessment of depressive sy mptomatology improvement: live naturalistic (N) performed by the patie nt's therapist, and from videotape record of structured clinical inter view (VSI) assessed by an independent rater out of five psychiatrists. Sixty-one newly admitted depressed inpatients, with a Montgomery and Asberg Depression Rating Scale (MADRS) total score above 20, were asse ssed before antidepressant treatment (DO), after 10 days (D10) and 4 w eeks of treatment (D28). Assessments were based on the MADRS and the D epression Retardation Rating Scale (DRRS) for both N and VSI methods, and on the SCL-90-R for self-rating. With the MADRS, the N method was shown to be more sensitive to symptomatology change than the VSI metho d, but the VSI method was more correlated to self-assessment than the N method was. However, these results were not replicated on the DRRS, for which an underscoring with the VSI method was evidenced as compare d to the N method. As shown in other studies, the poorest agreement be tween the two methods was evidenced at DO, suggesting a ''novelty effe ct'' particularly with the VSI method. This ''novelty effect'' may be all the more pronounced if a personality disorder is associated to dep ression. Consequently, information concerning each patient before rati ng videotapes is needed, as well as investigations in the field of dep ression and personality disorders. The greater change observed in MADR S with the N method as compared to the VSI method, may be due non-spec ific factors related mostly to therapist expectations by comparison to neutral raters. This hypothesis should be tested in the placebo group of a double-blind study, and, if confirmed, the use of VSI methods, b y minimising non-specific factors of improvement due to therapist expe ctations, may decrease the placebo response in antidepressant drug tri als. (C) 1998 Elsevier, Paris.