New standard of depression treatment: remission and full recovery

Major depressive disorder (MDD) is a chronic disorder that substantially impairs a patient's psychosocial and occupational functioning. Lifetime prevalence rates for MDD vary widely, ranging from 4.4% to approximately 20%, and it is predicted to become the second leading cause of disability by the year 2020. The magnitude of this public health problem, with its associated decreased quality of life, increased risk of suicide, loss of productivity, and increased health care use, underscores the importance of treating depressed patients to full remission. The presence of residual depressive symptoms due to partial or incomplete remission is associated with significant morbidity and mortality. Hence, complete remission should be the goal in the treatment of patients with MDD because it leads to a symptom-free state and a return to premorbid levels of functioning. Full remission and improved long-term prognosis can be achieved with long-term antidepressant therapy with newer agents that work through multireceptor mechanisms, especially through the serotonergic and noradrenergic systems (i.e., dual action). Robust efficacy and greater remission rates have been associated with dual-action agents.