Evolution of remission as the new standard in the treatment of depression

Epidemiologic and clinical data support the goal of treating depressed pati ents to wellness or full remission. Many patients improve but fail to achie ve full remission with antidepressant treatment and continue to have residu al symptoms, which cause distress and dysfunction. These residual symptoms may meet criteria for subsyndromal and minor depression. Patients who have these milder syndromes after treatment have a greater risk of relapse and r ecurrence than do those who remain symptom-free. Clinical trials of antidep ressants have shown lower rates of remission than of responses that fall sh ort of remission, although some dual-acting antidepressants (e.g., serotoni n-norepinephrine reuptake inhibitors) may have higher remission rates than other agents. Treatment with such robust dual-acting antidepressants may re sult in higher rates of remission and fewer residual symptoms than treatmen t with selective serotonin reuptake inhibitors.