Treatment of Major Depression: Is Improvement Enough?

The goals of antidepressant treatment are to induce remission and prevent relapse or recurrence. While response is the standard criterion applied to comparisons of antidepressant drugs indicating an improvement from baseline, the more stringent criterion of remission is more relevant to clinical practice because it indicates that the patient is asymptomatic (i.e., “well”). Patients may enter into a remission or partial remission, which is characterized by the presence of residual symptoms and an increased risk of relapse, impairment, and suicide. Studies with many antidepressants demonstrate response rates of 50% to 60% but remission rates of only 20% to 30%. Venlafaxine is an antidepressant that is characterized as a serotonin-norepinephrine reuptake inhibitor (SNRI). Using the criterion of remission, placebo-controlled and comparative trials demonstrate a higher remission rate with venlafaxine than with other antidepressants, thus improving the proportion of patients who are “well.” Selection of optimal antidepressant therapy should consider drugs that have the greatest potential to induce remission.