The concept of recovery in major depression
ABSTRACT There is increasing literature on the unsatisfactory degree of remission that current therapeutic strategies yield in unipolar depression. The aims of this review were to survey the available literature on residual symptoms of depression, to introduce new targets for therapy and to outline a more stringent definition of recovery.
Studies were identified by using MEDLINE (English language articles published from 1967 to June 2006; keywords: recovery, remission, residual symptoms, sequential treatment, drugs and psychotherapy, related to depressive disorder and depression) and a manual search of the literature and Index Medicus for the years 1960-2006.
Most patients report residual symptoms despite apparently successful treatment. Residual symptoms upon remission have a strong prognostic value. There appears to be a relationship between residual and prodromal symptomatology. The concept of recovery should involve psychological well-being.
Appraisal of subclinical symptomatology in depression has important implications for pathophysiological models of disease and relapse prevention. New therapeutic strategies for improving the level of remission, such as treatment on residual symptoms that progress to become prodromes of relapse, may yield more lasting benefits.
- SourceAvailable from: Tae-Youn Jun
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- "Associations between melancholic syndrome and differences in antidepressant treatment response therefore remain controversial. An additional drawback with previous research has been the restriction of treatment outcome measurement to depressive, although there have been recent calls for a more multifaceted evaluation including psychological well-being and functioning (Fava et al., 2007). To our knowledge, there have been few studies to investigate a range of treatment outcomes in MDD with melancholic features. "
ABSTRACT: BACKGROUND: This study aimed to determine whether major depressive disorders with melancholic and without melancholic features differ with respect to their responses to treatment with antidepressants. METHODS: From a nationwide sample of 18 hospitals in South Korea, 559 presenting patients with major depressive disorder were recruited. The DSM-IV based Structured Clinical Interview was administered for confirmatory diagnoses and depression subtypes with/without melancholic features. After baseline evaluation, they received naturalistic clinician-determined antidepressant interventions. Assessment scales for evaluating depression (HAMD), anxiety (HAMA), global severity (CGI-s), and functioning (SOFAS) were administered at baseline and re-evaluated at 1, 2, 4, 8, and 12 weeks later. RESULTS: At baseline, the 243 (43.5%) participants with melancholic features were more likely to have a previous history of depression, and had higher HAMA and lower SOFAS scores. After adjustment for baseline status, participants with melancholic features were more likely to achieve and to experience shorter times to CGI-s remission and associated with an enhanced global symptomatic remission with any antidepressant treatment. They were more likely to achieve and to experience shorter times to CGI-s remission and this difference was strongest in those receiving selective serotonin reuptake inhibitor (SSRI) antidepressants treatment. LIMITATIONS: The study was observational, and the treatment modality was naturalistic. CONCLUSIONS: These findings suggest a faster and more evident global response to pharmacotherapy in melancholia compared to other depressive syndromes, particularly where SSRI agents are used.Journal of Affective Disorders 07/2012; 144(1-2). DOI:10.1016/j.jad.2012.06.004 · 3.71 Impact Factor
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- "The major objective of this study was to describe and compare treatment outcomes based not only on depressive symptoms per se but also on other relevant indicators such as anxiety, global severity, and functioning. Although achieving remission of depressive symptoms is considered as the primary goal of treatment , recent discussions have suggested moving beyond remission to the achievement of psychological well-being and/or restoration of premorbid levels of functioning . The remission rate based on HAMD score was not different between those with or without comorbidity, while all the other treatment outcomes measuring anxiety, global severity, social and occupational functioning, as well as HAMD 'response', were significantly less improved in participants with comorbid physical disorders, even though there were no differences in the baseline scores on these assessment scales, except for HAMD. "
ABSTRACT: Physical and depressive disorders frequently co-occur, but effects of physical health on depression treatment outcomes have received little research. This study aimed to compare treatment outcomes between people with depressive disorder with and without comorbid physical disorders. A Korean nationwide sample of 723 people with depressive disorder initiated on antidepressant treatment, and re-evaluated at 1, 2, 4, 8, and 12 weeks later. Assessment scales for evaluating depressive symptoms (HAMD), anxiety (HAMA), global severity (CGI-s), and functioning (SOFAS) were administered at baseline and every follow-up visit. Achievement of remission or response was defined only when these were maintained to the 12 weeks study endpoint or to the last follow-up examination, if earlier, with the date of the first observed remission point applied as the timing of remission. Logistic regression and Cox proportional hazards models were used. Of the sample, 247 (34%) had at least one physical disorder. This was associated with lower socioeconomic status and more severe depressive symptoms at baseline, but was not associated with any treatment related characteristics including antidepressant type and regimen, concomitant medications, side effects, and duration of treatment period. After adjustment, patients with physical comorbidity responded more slowly and less often - particularly in domains of anxiety, global severity, and functioning (all p-values <.005). More intensive assessment and integrated treatment approaches are needed to facilitate treatment responses for depressive disorders in people with physical comorbidity. Future comparative studies between conventional and integrated treatment approaches are indicated for depressive disorders with physical comorbidity.Journal of psychosomatic research 11/2011; 71(5):311-8. DOI:10.1016/j.jpsychores.2011.05.001 · 2.84 Impact Factor
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- "Gender differences in antidepressant treatment response therefore remain controversial. An additional limitation in previous research has been that treatment outcome has been restricted to depressive symptoms, although there have been recent recommendations of a more multifaceted evaluation including psychological well-being and functioning (Fava et al., 2007). Another issue is that almost all previous research of this nature has been carried out in Western settings with potentially limited applicability in other ethnic groups and cultures. "
ABSTRACT: This study aimed to determine whether men and women with depression differ in socio-demographic, treatment-related characteristics, and in their responses to treatment with antidepressants, as well as to explore differences in treatment outcomes by menopausal status. From a nationwide sample of 18 hospitals in South Korea, 723 depressive patients were recruited. After baseline evaluation, they received naturalistic clinician-determined antidepressant interventions. Assessment scales for evaluating depression (HAMD), anxiety (HAMA), global severity (CGI-s), and functioning (SOFAS) were administered at baseline and re-evaluated at 1, 2, 4, 8, and 12 weeks later. At baseline, women were older, less educated, less likely to be employed, had lower income, were more likely to be married, and had longer illness duration than men. There were no gender differences in the treatment-regime received. After adjustment for baseline status, women were more likely to achieve HAMD remission (OR=1.51), HAMD response (OR=1.64), and HAMA response (OR=1.61). Women also experienced shorter times to HAMD response, HAMA response, and CGI-s remission. Postmenopausal women showed higher HAMA response with newer dual action antidepressants than premenopausal women. Women were found to have better outcomes following antidepressant treatment than men, and postmenopausal women had a better response on anxiety symptoms with newer dual action antidepressants.Psychiatry Research 08/2011; 189(1):82-90. DOI:10.1016/j.psychres.2010.12.027 · 2.68 Impact Factor