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Functional Recovery in Major Depressive Disorder: Focus on Early Optimized Treatment

Jeffrey Habert, MD, CCFP, FCFP; Martin A. Katzman, MD, FRCPC; Oloruntoba J. Oluboka, MD; Roger S. McIntyre, MD; Diane McIntosh, MD, FRCPC; Glenda M. MacQueen, MD, PhD; Atul Khullar, MD, FRCPC; Roumen V. Milev, MD, PhD, FRCPC; Kevin D. Kjernisted, MD; Pratap R. Chokka, MD; and Sidney H. Kennedy, MD, FRCPC

Published: September 1, 2016

Article Abstract

Objective: This article presents the case that a more rapid, individualized approach to treating major depressive disorder (MDD) may increase the likelihood of achieving full symptomatic and functional recovery for individual patients and that studies show it is possible to make earlier decisions about appropriateness of treatment in order to rapidly optimize that treatment.

Data Sources: A PubMed search was conducted using terms including major depressive disorder, early improvement, predictor, duration of untreated illness, and function. English-language articles published before September 2015 were included. Additional studies were found within identified research articles and reviews.

Study Selection: Thirty antidepressant studies reporting predictor criteria and outcome measures are included in this review.

Data Extraction: Studies were reviewed to extract definitions of predictors, outcome measures, and results of the predictor analysis. Results were summarized separately for studies reporting effects of early improvement, baseline characteristics, and duration of untreated depression.

Results: Shorter duration of the current depressive episode and duration of untreated depression are associated with better symptomatic and functional outcomes in MDD. Early improvement of depressive symptoms predicts positive symptomatic outcomes (response and remission), and early functional improvement predicts an increased likelihood of functional remission.

Conclusions: The approach to treatment of depression that exhibits the greatest potential for achieving full symptomatic and functional recovery is early optimized treatment: early diagnosis followed by rapid individualized treatment. Monitoring symptoms and function early in treatment is crucial to ensuring that patients do not remain on ineffective or poorly tolerated treatment, which may delay recovery and heighten the risk of residual functional deficits.

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