The clinical, psychosocial, and pharmacoeconomic ramifications of remission

At an estimated cost of almost $50 billion a year, the socioeconomic burden of major depressive disorder is enormous. Although remission has been iden tified as the key goal of treatment, such treatment must be highly acceptab le to patients, predictably effective, and carry minimal adverse effects. T he cornerstone of depression management, remission can improve clinical sta tus, functional ability, and quality of life for the patient while lowering utilization costs related to the disease and its comorbidities. Initially, the goals of therapy are to: (1) reduce and ultimately remove all signs an d symptoms of the depressive syndrome; (2) restore occupational and psychos ocial function to the asymptomatic state; and (3) achieve and maintain remi ssion. Most patients can achieve these goals with the help of antidepressan t medications, problem-focused psychotherapy, or a combination of the 2 met hods. Following an initial assessment of the patient, treatment of depressi on has 3 phases: acute, continuation, and maintenance. Although adherence t o treatment is crucial to successful treatment of depression, only about 25 % to 35% of patients will achieve remission after 6 to 8 weeks of treatment ; another 15% to 20% may remain depressed for months or years. Patients who achieve remission are much less likely to relapse than those who do not. M uch debate has focused on the relative merits of prescribing selective sero tonin reuptake inhibitors or venlafaxine. Results of a pooled analysis of 8 such comparative studies are presented.