Residual Symptoms in Depression: Can Treatment Be Symptom-Specific? [CME]
J Clin Psychiatry 2003;64(5):516-523
© Copyright 2014 Physicians Postgraduate Press, Inc.
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Background: Most patients with depression
continue to have symptoms after treatment. It is well documented
that these "residual" symptoms are common and are
associated with increases in suboptimal long-term outcomes such
as relapse and disability. While it is clear that residual
symptoms, as a group, contribute to poor outcomes, individual
residual symptoms have received relatively little attention. To
some extent, this lack of attention reflects an uncertainty in
the field about the relationship of the syndrome of depression to
the symptoms by which the syndrome is defined.
Method: Recognizing that for clinicians and
patients symptom relief is the goal of treatment, this article
reviews the evidence that a symptomatic approach to individual
residual symptoms is both feasible and useful. Evidence was
gathered through a MEDLINE review of articles published in
English from 1966 to 2002. Multiple keywords relating to
symptoms, depression, and treatment were used.
Results: Many of the agents that psychiatrists
use for augmentation of depression treatment, such as
psychostimulants and alerting agents, atypical antipsychotics and
mood stabilizers, and buspirone and benzodiazepines, have
specific symptomatic effects, which raises the question of
whether we are augmenting the core antidepressant effect or
providing symptomatic relief. Fatigue, anxiety, sexual
dysfunction, and sleep disturbances are all symptoms that are
commonly leftover after treatment of depression. Some data
indicate that treatment of these residual symptoms is efficacious
and may affect the long-term outcome of depression.
Discussion: This discussion of the treatment of
residual depressive symptoms raises a variety of research
questions that should be addressed. Also implicit in this
discussion are theoretical questions on the relationship between
symptoms and syndrome.