title: Strategies for achieving full remission when first-line antidepressants are not enough.
abstract: Remission rates for patients with major depressive disorder are discouragingly low. Even when first-line treatment is administered at an adequate dose for a sufficient duration, approximately two-thirds of patients will fail to achieve remission, and many who remit have residual symptoms. Clinicians must assess problems with the first treatment and select the most appropriate second-line treatment based on patient preference, clinical judgment, and any comorbid conditions. Strategies like implementing psychotherapy, switching agents, or augmenting antidepressants may help patients achieve remission. Patients may also require adjunctive therapy to target common residual symptoms such as fatigue or insomnia.
authors.affiliation: From the Department of Psychiatry and the Depression Clinical and Research Program, Harvard Medical School and Massachusetts General Hospital, Boston.
authors.forename: Andrew A
authors.initials: AA
authors.lastname: Nierenberg
mesh_terms: D000928:Antidepressive Agents / Q000008:administration & dosage / Q000145:classification / Q000493:pharmacokinetics; D003131:Combined Modality Therapy; D057186:Comparative Effectiveness Research; D003863:Depression / Q000175:diagnosis / Q000628:therapy*; D004305:Dose-Response Relationship, Drug; D057915:Drug Substitution / Q000379:methods; D004359:Drug Therapy, Combination / Q000379:methods; D006801:Humans; D017063:Outcome Assessment, Health Care; D011613:Psychotherapy / Q000379:methods*; D011619:Psychotropic Drugs; D012074:Remission Induction / Q000379:methods; D055502:Secondary Prevention; D013810:Therapeutic Equivalency; D016896:Treatment Outcome
chemical_list: D000928:Antidepressive Agents; D011619:Psychotropic Drugs