An approach to managing depression. Defining and measuring outcomes.
OBJECTIVE
To provide family physicians with a contemporary approach to formulating a treatment model for major depressive disorder that integrates definitions of new therapeutic end points, familiarizes them with tools for assessing these end points, and describes newer methods for enhancing outcome.


METHODS
Canadian Psychiatric Association Guidelines for the Treatment of Depressive Disorders, relevant articles from a MEDLINE search using the MeSH headings"full remission" and "depression," and the authors' clinical experience.


RESULTS
Major depressive disorder is an episodic, relapsing, and sometimes chronic illness. Depressive symptoms in primary care settings are often vague reports of anhedonia, anxiety, and nonspecific somatic complaints. Therapeutic objectives in depression are full remission of depressive symptoms, prevention of recurrence, and restoration of function. Depression rating scales can be useful for monitoring and treating depression.


CONCLUSIONS
The proposed therapeutic model anticipates the chronic course of illness, defines treatment end points, encourages longer duration of treatment, and includes both pharmacologic and lifestyle therapies. The 7-item Hamilton Depression Rating Scale can assist clinicians in determining when full remission has occurred.
Khullar
Atul
A
Department of Psychiatry, University of Alberta, Edmonton.
McIntyre
Roger S
RS
D000928:Antidepressive Agents / Q000627:therapeutic use; D001714:Bipolar Disorder / Q000175:diagnosis; D003131:Combined Modality Therapy; D003865:Major Depressive Disorder / Q000175:diagnosis* / Q000628:therapy*; D003937:Diagnosis, Differential; D006801:Humans; D011569:Psychiatric Status Rating Scales; D011613:Psychotherapy
D000928:Antidepressive Agents