Update on partial response in depression.
Full symptomatic remission is the optimal outcome for patients with major depression. Unfortunately, antidepressant efficacy is limited to partial response for a significant minority of patients. Incomplete remission of depressive symptoms is associated with increased risk of relapse, decreased functioning in work and social settings, and increased risk of eventual suicide. Factors that increase the likelihood of incomplete remission include chronicity, severe symptomatology, and comorbid illnesses. Strategies to manage incomplete remission include "watchful waiting" (ie, continuing the original medication for another 4 to 8 weeks to see if complete remission will develop), switching antidepressants, or adding a second, adjunctive treatment (ie, either beginning psychotherapy or a second medication to augment the original antidepressant). Augmentation strategies may well prove to be the preferred strategy for improving response if tolerability is not an issue. Although studies on predictive factors have not yielded definitive results, clinicians in practice often select adjunctive agents that target patients' persistent symptoms.
Thase
Michael E
ME
Department of Psychiatry, University of Pennsylvania School of Medicine, Philadelphia Veterans Affairs Medical Center, and Pittsburgh Medical Center, Philadelphia and Pittsburgh, USA. thase@mail.med.upenn.edu
D000928:Antidepressive Agents / Q000627:therapeutic use*; D014150:Antipsychotic Agents / Q000627:therapeutic use; D001008:Anxiety Disorders / Q000188:drug therapy / Q000453:epidemiology; D002908:Chronic Disease; D015283:Citalopram / Q000627:therapeutic use; D015897:Comorbidity; D003865:Major Depressive Disorder / Q000188:drug therapy* / Q000453:epidemiology / Q000523:psychology; D004359:Drug Therapy, Combination; D006801:Humans; D018020:Lithium Compounds / Q000627:therapeutic use; D017410:Practice Guidelines as Topic / Q000592:standards; D016032:Randomized Controlled Trials as Topic / Q000706:statistics & numerical data; D012008:Recurrence; D018570:Risk Assessment; D012720:Severity of Illness Index; D016896:Treatment Outcome
D000928:Antidepressive Agents; D014150:Antipsychotic Agents; D018020:Lithium Compounds; D015283:Citalopram