The Primary Care Companion to The Journal of Clinical Psychiatry is again pleased to offer our readers an opportunity to share a supplement to our sister journal. Dr. Michael E. Thase of Western Psychiatric Institute and Clinic serves as guest editor of this overview of current information on treatment goals for patients with depression and anxiety. He is joined by other significant researchers in the field of psychiatry—Andrew A. Nierenberg, Emma C. Wright, Philip T. Ninan, John P. Feighner, David V. Sheehan, and James C. Ballenger—representing Harvard Medical School, Emory University School of Medicine, the Feigner Research Institute, University of South Florida, and the Medical University of South Carolina.
The topic of this supplement is one that we have visited before in The Primary Care Companion, expressed by the phrase "'better' is not 'well.'" Moreover, as more information becomes available on the outcomes of depression treatment, it is evident that better is not good enough. Less robust responses to treatment mean residual dysfunction and higher relapse risks. These facts call even further into question the validity of definitions of response used in the usual placebo-controlled trials of antidepressant medications. In these trials, a 50% improvement in symptoms at 8 weeks moved a participant into the responder category. In view of these findings, the world of research needs to sit up and listen. Clinicians, likewise, should not ask researchers and pharmaceutical representatives "Does it work?" but "Does it work completely?"
Dr. Thase and colleagues focus on mixed anxious and depressive presentations of illness. This is very appropriate for us in primary care, since those are the presentations we most often encounter. Elimination of depressive and anxious symptoms will allow patients to recover normal functioning and, where appropriate, allow psychotherapy to proceed unimpeded by such obstacles.
The bar for the treatment of depression and anxiety is higher than we once assumed. Primary care practitioners, like their colleagues in psychiatry, can use the information in this supplement to take their clinical skills to the next level. Enjoy!
J. Sloan Manning, M.D.
Editor in Chief
The Primary Care Companion to the Journal of Clinical Psychiatry