Achieving Remission and Managing Relapse in Depression

Although antidepressants are effective, no more than one third of the depressed patients who begintreatment achieve full remission within 8 weeks of therapy. Remission, defined as virtually completerelief of symptoms and return to full functioning in all areas of life, should be thought of as the optimalgoal for the initial phase of treatment of depression. This goal is recommended because residualsymptoms (i.e., response without remission) are associated with a myriad of risks, including a higherrate of relapse. When compared with monotherapy, selective serotonin reuptake inhibitor (i.e., the currentfirst-line standard of care) strategies may improve remission rates. These strategies include usingmaximally tolerated (i.e., higher than usual) doses of medication, switching to an antidepressantthought to have more than one mechanism of action, combining dissimilar medications (to presumablytreat a broader range of symptoms), and using a combination of psychotherapy and medication.Ensuring that patients are indeed adherent with treatment is also worthwhile before assuming that atreatment has failed.