ArticleFrontiers in psychiatry2026
Episode-wide Maudsley staging in treatment-resistant depression: a longitudinal tertiary-care comparison of dimensional and categorical outcomes.
Article in Frontiers in psychiatry, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Unlike typical categorical definitions of treatment-resistant depression (TRD) based on antidepressant (AD) trial failures, the Maudsley Staging Method (MSM) is a dimensional measure of resistance also rating episode duration, baseline depression severity and failure of augmentation strategies and ECT. However, MSM has not previously been used longitudinally across the full depressive episode, from episode onset to remission. We applied episode-wide MSM (EW-MSM) in patients with Major Depressive Disorder naturalistically followed to remission in a tertiary-care setting and categorized as 1 Methods: We recruited 267 patients. EW-MSM was scored at remission (MADRS ≤ 9 in two consecutive visits), if achieved. Associations of clinicodemographic and treatment-related characteristics with EW-MSM and categorical outcomes were explored in multivariate models. Their comparative predictive value for depression improvement was tested in hierarchical linear regressions. ROC curves assessed EW-MSM discriminative utility across categorical outcomes. Results: Analysis focused on 233 remitters (105 1 Limitations: Single, tertiary-care setting, unavailability of ECT/esketamine and exclusion of patients on psychotherapy (not rated by MSM) limit study generalizability. Conclusions: EW-MSM reflects clinical and treatment intensity aspects of resistance in depression more strongly and comprehensively than categorical outcomes. Therefore, it offers precision for staging and could be used to more efficiently investigate clinical, biological and psychological correlates of resistance.
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