Outcomes in major depressive disorder: The evolving concept of remission and its implications for treatment

Abstract

It is increasingly recognised that major depressive disorder can be a chronic condition with many patients experiencing recurrent episodes. Remission from a depressive episode implies the absence or near absence of depressive symptoms. However, for many patients the periods between depressive episodes are not symptom free. Residual symptoms are predictors of relapse or recurrence, and may be associated with residual psychosocial impairment. In clinical studies, remission is commonly defined using a cut-off score on a rating scale for depressive symptoms, such as a score of < or = 7 on the 17-item Hamilton scale. However, there is debate about which scales and cut-offs are optimal and full-length rating scales are not widely used in clinical practice. In spite of such issues, it seems clear that a therapy should aim at the most complete remission possible. Unfortunately, recent studies have highlighted that in clinical practice usually only a low rate of remission is achieved. Although long-term treatment with antidepressants can reduce the risk of relapse or recurrence only a minority of patients in clinical practice achieve this as treatment is often prematurely stopped due to long-term side effects such as sleep disturbance, sexual dysfunctioning and weight gain. Therefore, it represents an unmet need to come up with antidepressant drugs of greater efficacy and improved tolerability as such treatments could lead to more complete remission in more patients.

Changes of Serum Concentrations of Brain-Derived Neurotrophic Factor (BDNF) during Treatment with Venlafaxine and Mirtazapine: Role of Medication and Response to Treatment

“…Patients with less than 18 points at the end of the drug-free run-in period or a drop of ≥ 10 points during that period (week − 1) were excluded from the study as responders during washout. Remission was defi ned as a fi nal HDRS score of ≤ 7 [ 24 ] .…”

Psychiatric diagnoses during institutionalization: an investigation of 1334 psychiatric patients hospitalized in an Italian asylum during the 20th Century

“…Also, the majority of patients aff ected by mood disorders, are not symptom free during the periods between episodes [26]. Patients with mood disorders at "Santa Maria della Pietà" almost doubled from 1920 to 1960, and a further increase was observed from 1970 to 1980 during which the psychopharmacological era highlighted new valid alternatives of care.…”

Translational identification of transcriptional signatures of major depression and antidepressant response

“…Diagnosis of MDD still mainly relies on subjective evaluation, such as self-reporting of symptoms and clinical interviews (Young et al, 2016). Although modern pharmacological medications such as selective serotonin reuptake inhibitors (SSRIs) and more recently serotoninnorepinephrine reuptakes inhibitors (SNRIs, e.g., duloxetine), has demonstrated efficacy and potential to prevent negative consequences (such as suicidal behavior) associated with MDD (Girardi et al, 2009), the optimal therapies to manage MDD remain unclear, as more than 20% of MDD patients remain resistant to treatments and around 50% of the episodes are recurrent (Kessler, 2003;Möller, 2008). Therefore, there is a need for improvement of MDD patient medical care and identification of reliable biomarkers could help in diagnosis, classification of MDD subtypes, and monitoring of disease progression (Jentsch et al, 2015;Young et al, 2016).…”