Achieving Remission and Managing Relapse in Depression
J Clin Psychiatry 2003;64(suppl 18):3-7
© Copyright 2015 Physicians Postgraduate Press, Inc.
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Although antidepressants are effective, no more than one third of the depressed patients who begin
treatment achieve full remission within 8 weeks of therapy. Remission, defined as virtually complete
relief of symptoms and return to full functioning in all areas of life, should be thought of as the optimal
goal for the initial phase of treatment of depression. This goal is recommended because residual
symptoms (i.e., response without remission) are associated with a myriad of risks, including a higher
rate of relapse. When compared with monotherapy, selective serotonin reuptake inhibitor (i.e., the current
first-line standard of care) strategies may improve remission rates. These strategies include using
maximally tolerated (i.e., higher than usual) doses of medication, switching to an antidepressant
thought to have more than one mechanism of action, combining dissimilar medications (to presumably
treat 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 a
treatment has failed.