Clinician Perspective on Achieving and Maintaining Remission in Depression

The majority of large-scale clinical trials of depression focus on response, typically defined as a50% reduction in symptoms, as the endpoint. Response in the absence of remission places patients atgreater risk for relapse, decreases their level of functioning, and erodes quality of life. Most importantly,both research and our clinical experience suggest that remission, or “getting well,” is an attainablegoal for patients with major depressive disorders. Pharmacotherapy, psychotherapy, and combinationregimens are all treatment options. Recent studies across a range of patient populations havedemonstrated the benefit of affecting multiple transmitter systems over a single antidepressant mechanism.Pooled data from more than 2000 patients comparing venlafaxine, a serotonin-norepinephrinereuptake inhibitor, and selective serotonin reuptake inhibitors suggest that the dual mechanism ofaction of venlafaxine provides significantly greater efficacy in achieving remission. Ultimately, achievinga good clinical outcome is desirable, but sustaining the mood state is, perhaps, more important.Studies of venlafaxine show it is possible to prevent more relapses and recurrences of depression withdual-mechanism treatment than with placebo. These data highlight the need for setting appropriatelyaggressive goals and working closely with our patients to achieve them. By doing so, we create thebest opportunity for restoring patients to “wellness” and, ultimately, a normal and fulfilling life.