Treatment of major depression:
is improvement enough?
Ferrier IN
Department of Psychiatry, University of Newcastle,
Newcastle-Upon-Tyne, United Kingdom.
J Clin Psychiatry 1999; 60 Suppl 6:10-4
ABSTRACT
The goals of antidepressant treatment are to
induce remission and prevent relapse or recurrence. While response is the
standard criterion applied to comparisons of antidepressant drugs indicating
an improvement from baseline, the more stringent criterion of remission is
more relevant to clinical practice because it indicates that the patient is
asymptomatic (i.e., "well"). Patients may enter into a remission
or partial remission, which is characterized by the presence of residual
symptoms and an increased risk of relapse, impairment, and suicide. Studies
with many antidepressants demonstrate response rates of 50% to 60% but
remission rates of only 20% to 30%. Venlafaxine is an antidepressant that is
characterized as a serotonin-norepinephrine reuptake inhibitor (SNRI). Using
the criterion of remission, placebo-controlled and comparative trials
demonstrate a higher remission rate with venlafaxine than with other
antidepressants, thus improving the proportion of patients who are
"well." Selection of optimal antidepressant therapy should
consider drugs that have the greatest potential to induce remission.
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