Update on Partial Response in Depression




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Full symptomatic remission is the optimal outcome for patients with major depression. Unfortunately, antidepressant efficacy is limited topartial response for a significant minority of patients. Incomplete remission of depressive symptoms is associated with increased risk of relapse, decreased functioning in work and social settings, and increased risk of eventual suicide. Factors that increase the likelihood of incomplete remission include chronicity, severe symptomatology, and comorbid illnesses. Strategies to manage incomplete remission include “watchful waiting” (ie, continuing the original medication for another 4 to 8 weeks to see if complete remission will develop), switching antidepressants, or adding a second, adjunctive treatment (ie, either beginning psychotherapy or a second medication to augment the original antidepressant). Augmentation strategies may well prove to be the preferred strategy for improving response if tolerability is not an issue. Although studies on predictive factors have not yielded definitive results, clinicians in practice often select adjunctive agents that target patients’ persistent symptoms.

From the Departments of Psychiatry, University of Pennsylvania School of Medicine, Philadelphia Veterans Affairs Medical Center, and Pittsburgh Medical Center, Philadelphia and Pittsburgh.

This article is derived from the planning teleconference series “Tackling Partial Remission to Depression Treatment,” which was held in March and April 2009 and supported by an educational grant from Bristol-Myers Squibb Company and Otsuka America Pharmaceutical, Inc.

Dr Thase is a consultant for AstraZeneca, Bristol-Myers Squibb, Eli Lilly, Forest, GlaxoSmithKline, Janssen, MedAvante, Neuronetics, Novartis, Pfizer, Schering-Plough, Sepracor, Shire US, Supernus, Transcept, and Wyeth; currently is a member of the speakers’ bureaus for AstraZeneca, Bristol-Myers Squibb, Eli Lilly, and Wyeth; has equity holdings in MedAvante; receives royalties from American Psychiatric Publishing, Inc, Guilford Publications, Herald House, and W.W. Norton & Company; has provided expert testimony for Jones Day (Wyeth litigation), Philips Lyttle, LLP (GlaxoSmithKline litigation), and Pepper Hamilton, LLP (Eli Lilly litigation); has received research funding (during the past 3 years) from Eli Lilly, Forest, GlaxoSmithKline, Sepracor, and the National Institute of Mental Health; and his spouse is an employee of Advogent, which does business with Bristol-Myers Squibb and Wyeth.

Corresponding author: Michael E. Thase, MD, University of Pittsburgh School of Medicine, 3535 Market St, Suite 670, Philadelphia, PA 19104 (thase@mail.med.upenn.edu).

J Clin Psychiatry 2009;70(suppl 6):04-09