MADRS

The Montgomery–Åsberg Depression Rating Scale (MADRS) is a widely used clinician‐rated rating in psychedelic clinical trials to measure depressive severity. MADRS is a 10-item clinician-administered scale covering:

• Apparent sadness
• Reported sadness
• Inner tension
• Reduced sleep
• Reduced appetite
• Concentration difficulties
• Lassitude
• Inability to feel
• Pessimistic thoughts
• Suicidal thoughts

Each item yields a score of 0 to 6; the overall score thus ranges from 0 to 60. One of the largest psychedelic (psilocybin) studies has found that a 2.5mg dose can lead to a 6.6 point reduction in MADRS score. Higher MADRS score indicates more severe depression. Usual cutoff points are:

• 0 to 6: normal /symptom absent
• 7 to 19: mild depression
• 20 to 34: moderate depression
• 35 to 60: severe depression.

Role of MADRS in Psychedelic Therapy

• Baseline Assessment: Before undergoing psychedelic therapy, patients are often assessed using the MADRS to establish a baseline of their depressive symptoms. This helps clinicians understand the severity of depression and tailor the therapeutic approach accordingly.
• Outcome Measurement: After the therapy sessions, MADRS is used again to evaluate the effectiveness of the treatment. A significant reduction in the MADRS score would indicate a decrease in depressive symptoms, suggesting the therapy was effective.
• Safety and Monitoring: Tracking changes in MADRS scores can also help clinicians monitor any potential negative reactions or worsening of symptoms after the therapy. This is crucial given the profound psychological effects that psychedelics can induce.
• Research and Development: As psychedelic therapy is still an emerging field, research studies often utilize MADRS to provide quantifiable data on the efficacy of these treatments. It's a standardized measure that allows for comparisons between different studies and therapeutic approaches.

Advantages

• Specificity: Unlike some other scales, MADRS focuses more on the psychological symptoms of depression, such as pessimistic thoughts and suicidal ideation. This can be particularly relevant in the context of psychedelic therapy, which often delves deep into patients' psychological states.
• Sensitivity to Change: The MADRS has been shown to be sensitive to changes in depressive symptoms, making it a valuable tool for tracking progress in therapeutic settings.

Limitations:

While the MADRS is a valuable tool, it's essential to combine its findings with other clinical observations and potentially other assessment tools. This is especially true in psychedelic therapy, where profound existential and spiritual experiences might not be fully captured by traditional depression rating scales.

References