Maudsley Staging Method Effectively Predicts Course of Depression

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The Maudsley Staging Method may be a valuable tool for quantifying treatment-resistant depression.

The Maudsley Staging Method can be used to effectively quantify treatment-resistant depression in order to predict the course of depression and improve clinical outcomes, according to a study published in The Journal of Clinical Psychiatry.

The current study sought to validate the Maudsley Staging Method as a predictive tool of treatment resistance and depression outcomes in 643 depressed subjects. In order to examine a wide spectrum of treatment resistance, individuals from the general population were included along with primary and secondary care patients from the Netherlands Study of Depression and Anxiety (NESDA). All subjects were diagnosed with major depressive disorder within 6 months of the study according to the Composite Interview Diagnostic Instrument and demonstrated moderately severe depression (>24 baseline score) according to the Inventory of Depressive Symptomatology Self-Report.

The Maudsley Staging Method determines a composite score based on 3 factors: duration, severity, and treatment failures, which in this study were scored retrospectively based on variables recorded in the NESDA database. The Maudsley Staging Method composite score was used to predict prospectively the course of depression. The predictions where compared with primary outcomes reported during a 2-year follow-up period.

Primary outcomes were described by the percentage of follow-up time subjects reported feeling depressed (≥50% of the follow-up). The Maudsley Staging Method accurately predicted the time spent in a depressive episode (P <.001) and demonstrated a significant association with the independent variable “persistent depression” (OR=1.40; 95% CI, 1.23-1.60; P <.001). Whether the subjects had yet undergone pharmacologic treatment at baseline was insignificant, suggesting the Maudsley Staging Method approach can predict a depression trajectory in a sample of patients with a range in severity and with a less extensive treatment history.

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Limitations of the study included that NESDA is a naturalistic cohort study and that the exact treatment data of the study population were unavailable or extremely limited. Why physicians pursued certain treatment strategies or received different outcomes associated with treatment resistance was also insufficiently addressed by the study data.

The study results offered validation of the Maudsley Staging Method approach to predict worse depression outcomes, specifically the failure to achieve remission, as well as anticipate the severity and duration of a depressive episode in assessing future treatment resistance.


van Belkum SM, Geugies H, Lysen TS, et. al. Validity of the Maudsley staging method in predicting treatment-resistant depression outcome using the Netherlands Study of Depression and Anxiety [published online January 2018]. J Clin Psychaitry. doi: 10.4088/JCP.17m11475