title: Pharmacological approaches to manage persistent symptoms of major depressive disorder: rationale and therapeutic strategies.
abstract: Major depressive disorder (MDD) is a highly prevalent chronic psychiatric illness associated with significant morbidity, mortality, loss of productivity, and diminished quality of life. Typically, only a minority of patients responds to treatment and meet criteria for remission as residual symptoms may persist, the result of an inadequate course of treatment and/or the presence of persistent side effects. The foremost goal of treatment should be to restore patients to full functioning and eliminate or relieve all MDD symptoms, while being virtually free of troublesome side effects. The current available pharmacological options to manage persistent depressive symptoms include augmentation or adjunctive combination strategies, both of which target selected psychobiological systems and specific mood and somatic symptoms experienced by the patient. As well, non-pharmacological interventions including psychotherapies may be used in either first-line or adjunctive approaches. However, the evidence to date with respect to available adjunct therapies is limited by few studies and those published have utilized only a small number of subjects and lack enough data to allow for a consensus of expert opinion. This underlines the need for further longer term, large population-based studies and those that include comorbid populations, all of which are seen in real world community psychiatry.
authors.affiliation: START Clinic for Mood and Anxiety Disorders, Toronto, ON, Canada; Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada. Electronic address: iepstein@startclinic.ca.
authors.forename: Irvin
authors.initials: I
authors.lastname: Epstein
authors.affiliation: START Clinic for Mood and Anxiety Disorders, Toronto, ON, Canada.
authors.forename: Isaac
authors.initials: I
authors.lastname: Szpindel
authors.affiliation: START Clinic for Mood and Anxiety Disorders, Toronto, ON, Canada; Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Northern Ontario School of Medicine, Thunder Bay, ON, Canada; Department of Psychology, Lakehead University, Thunder Bay, ON, Canada; Adler Graduate Professional School, Toronto, ON, Canada.
authors.forename: Martin A
authors.initials: MA
authors.lastname: Katzman
mesh_terms: D003131:Combined Modality Therapy; D003865:Major Depressive Disorder / Q000188:drug therapy* / Q000523:psychology; D061218:Depressive Disorder, Treatment-Resistant / Q000188:drug therapy* / Q000523:psychology; D019468:Disease Management; D006801:Humans; D011613:Psychotherapy; D011619:Psychotropic Drugs / Q000627:therapeutic use*; D011788:Quality of Life; D012074:Remission Induction / Q000379:methods
chemical_list: D011619:Psychotropic Drugs
keywords: Adjunct therapy; Comorbidity; Incomplete remission; Major depressive disorder; Residual symptoms; Treatment resistant depression