Functional Recovery in Major Depressive Disorder: Focus on Early Optimized Treatment.
OBJECTIVE
This article presents the case that a more rapid, individualized approach to treating major depressive disorder (MDD) may increase the likelihood of achieving full symptomatic and functional recovery for individual patients and that studies show it is possible to make earlier decisions about appropriateness of treatment in order to rapidly optimize that treatment.


METHODS
A PubMed search was conducted using terms including major depressive disorder, early improvement, predictor, duration of untreated illness, and function. English-language articles published before September 2015 were included. Additional studies were found within identified research articles and reviews.


METHODS
Thirty antidepressant studies reporting predictor criteria and outcome measures are included in this review.


METHODS
Studies were reviewed to extract definitions of predictors, outcome measures, and results of the predictor analysis. Results were summarized separately for studies reporting effects of early improvement, baseline characteristics, and duration of untreated depression.


RESULTS
Shorter duration of the current depressive episode and duration of untreated depression are associated with better symptomatic and functional outcomes in MDD. Early improvement of depressive symptoms predicts positive symptomatic outcomes (response and remission), and early functional improvement predicts an increased likelihood of functional remission.


CONCLUSIONS
The approach to treatment of depression that exhibits the greatest potential for achieving full symptomatic and functional recovery is early optimized treatment: early diagnosis followed by rapid individualized treatment. Monitoring symptoms and function early in treatment is crucial to ensuring that patients do not remain on ineffective or poorly tolerated treatment, which may delay recovery and heighten the risk of residual functional deficits.
Department of Family Medicine, University of Toronto, 206-2900 Steeles Ave E, Thornhill, ON L3T 4X1 Canada. jhabert@rogers.com.|Department of Family and Community Medicine, University of Toronto, Ontario, Canada.
Jeffrey
J
Habert
START Clinic for Mood and Anxiety Disorders, Toronto, Ontario, Canada.
Martin A
MA
Katzman
Department of Psychiatry, University of Calgary, Alberta, Canada.
Oloruntoba J
OJ
Oluboka
Department of Psychiatry and Pharmacology, University of Toronto, Ontario, Canada.
Roger S
RS
McIntyre
Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada.
Diane
D
McIntosh
Mathison Centre for Mental Health Research and Education, Cumming School of Medicine, University of Calgary, Alberta, Canada.
Glenda M
GM
MacQueen
Department of Psychiatry, University of Alberta, Edmonton, Alberta, Canada.
Atul
A
Khullar
Department of Psychiatry, Queen's University, Kingston, Ontario, Canada.
Roumen V
RV
Milev
Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada.
Kevin D
KD
Kjernisted
Department of Psychiatry, University of Alberta, Edmonton, Alberta, Canada.
Pratap R
PR
Chokka
Department of Psychiatry, University of Toronto, Ontario, Canada.
Sidney H
SH
Kennedy
D000928:Antidepressive Agents / Q000627:therapeutic use*; D003865:Major Depressive Disorder / Q000175:diagnosis / Q000188:drug therapy*; D042241:Early Diagnosis; D005260:Female; D006801:Humans; D008297:Male; D057285:Precision Medicine; D016896:Treatment Outcome
D000928:Antidepressive Agents