title: Report by the ACNP Task Force on response and remission in major depressive disorder.
abstract: This report summarizes recommendations from the ACNP Task Force on the conceptualization of remission and its implications for defining recovery, relapse, recurrence, and response for clinical investigators and practicing clinicians. Given the strong implications of remission for better function and a better prognosis, remission is a valid, clinically relevant end point for both practitioners and investigators. Not all depressed patients, however, will reach remission. Response is a less desirable primary outcome in trials because it depends highly on the initial (often single) baseline measure of symptom severity. It is recommended that remission be ascribed after 3 consecutive weeks during which minimal symptom status (absence of both sadness and reduced interest/pleasure along with the presence of fewer than three of the remaining seven DSM-IV-TR diagnostic criterion symptoms) is maintained. Once achieved, remission can only be lost if followed by a relapse. Recovery is ascribed after at least 4 months following the onset of remission, during which a relapse has not occurred. Recovery, once achieved, can only be lost if followed by a recurrence. Day-to-day functioning and quality of life are important secondary end points, but they were not included in the proposed definitions of response, remission, recovery, relapse, or recurrence. These recommendations suggest that symptom ratings that measure all nine criterion symptom domains to define a major depressive episode are preferred as they provide a more certain ascertainment of remission. These recommendations were based largely on logic, the need for internal consistency, and clinical experience owing to the lack of empirical evidence to test these concepts. Research to evaluate these recommendations empirically is needed.
authors.affiliation: Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX 75390-9086, USA. john.rush@utsouthwestern.edu
authors.forename: A John
authors.initials: AJ
authors.lastname: Rush
authors.forename: Helena C
authors.initials: HC
authors.lastname: Kraemer
authors.forename: Harold A
authors.initials: HA
authors.lastname: Sackeim
authors.forename: Maurizio
authors.initials: M
authors.lastname: Fava
authors.forename: Madhukar H
authors.initials: MH
authors.lastname: Trivedi
authors.forename: Ellen
authors.initials: E
authors.lastname: Frank
authors.forename: Philip T
authors.initials: PT
authors.lastname: Ninan
authors.forename: Michael E
authors.initials: ME
authors.lastname: Thase
authors.forename: Alan J
authors.initials: AJ
authors.lastname: Gelenberg
authors.forename: David J
authors.initials: DJ
authors.lastname: Kupfer
authors.forename: Darrel A
authors.initials: DA
authors.lastname: Regier
authors.forename: Jerrold F
authors.initials: JF
authors.lastname: Rosenbaum
authors.forename: Oakley
authors.initials: O
authors.lastname: Ray
authors.forename: Alan F
authors.initials: AF
authors.lastname: Schatzberg
mesh_terms: D002986:Clinical Trials as Topic; D003865:Major Depressive Disorder / Q000175:diagnosis / Q000188:drug therapy* / Q000523:psychology* / Q000628:therapy; D006801:Humans; D012008:Recurrence; D012107:Research Design