Characterizing the Ideal Antidepressant Therapy to Achieve Remission

A paradigm shift in the management of depression has transpired in recent years with the modificationof treatment goals toward remission, an outcome that transcends response. Pharmacotherapy,psychotherapy, electroconvulsive therapy, and combination therapies are treatment modalities availableto the clinician for facilitating remission in depressed patients. For patients with moderate-to-severe depression, pharmacotherapy, either alone or in combination with other therapeutic approaches,is the treatment of choice. Antidepressants have heterogeneous effects on neurotransmittersystems that are manifested in different levels of selectivity and potency, influencing the drugs’ safetyprofile through their potential for inducing drug-drug interactions. In terms of the pharmacokinetic-pharmacodynamiccharacteristics of antidepressants, a positive dose-response relationship has beenshown to enhance the achievement of full remission because it allows the clinician to maximize drugdosage to optimize efficacy. Evidence from several studies indicates that treatment strategies that involvecombined serotonergic and noradrenergic mechanisms result in pharmacologic synergism thatleads to an enhanced antidepressant effect. This article identifies key characteristics of antidepressantsthat have been associated with greater efficacy.