Realistic Expectations and a Disease Management Model for Depressed Patients With Persistent Symptoms

Gabor I. Keitner, M.D.; Christine E. Ryan, Ph.D.; and David A. Solomon, M.D.

Objective: To describe the efficacy of currently available treatments for depression in achieving remission and to highlight additional strategies for those patients who continue to experience persistent depressive symptoms in spite of optimal treatment.

Data Sources: The authors reviewed the literature (electronic and hand searches) on the efficacy of current pharmacologic and psychotherapeutic antidepressant treatments and the utility of a chronic disease management model. A search of PubMed was conducted for English-language articles published from 1980 to 2005 using the keywords depression treatments, outcome, course of illness, and treatment resistant depression.

Data Synthesis: Current treatments for depression leave a significant minority (20%-40%) of patients with persistent depressive symptoms. A disease management model that may be useful for major depressive disorder is described.

Conclusions: The goal of treating depression to achieve remission, although ideal, is currently unattainable for many patients. The long-term care of patients with persisting depressive symptoms may be well served by adding a disease management component to the overall treatment strategy. Doing so may help to improve coping, interpersonal functioning, and quality of life.

(J Clin Psychiatry 2006;67:1412-1421)

Received Jan. 24, 2006; accepted April 11, 2006. From the Brown University School of Medicine and Rhode Island Hospital, Providence, R.I.

There was no external funding provided for the preparation of this manuscript.

In the spirit of full disclosure and in compliance with all ACCME Essential Areas and Policies, the faculty for this CME article were asked to complete a statement regarding all relevant financial relationships between themselves or their spouse/partner and any commercial interest (i.e., a proprietary entity producing health care goods or services) occurring within at least 12 months prior to joining this activity. The CME Institute has resolved any conflicts of interest that were identified. The disclosures are as follows: Dr. Keitner has received grant/research support from Janssen, Novartis, and AstraZeneca and has been on the speakers bureau of Janssen. Drs. Ryan and Solomon have no personal affiliations or financial relationships with any proprietary entity producing health care goods or services consumed by, or used on, patients to disclose relative to the article.

The authors thank Richard Goldberg, M.D., and Timothy Petersen, Ph.D., for their helpful review of this manuscript.

Corresponding author and reprints: Gabor I. Keitner, M.D., Department of Psychiatry, Rhode Island Hospital, 593 Eddy St., Providence, RI 02903 (e-mail: gkeitner@lifespan.org).