Optimizing treatment outcomes for patients with depression and generalized anxiety disorder

The goal of the acute phase of pharmacotherapy of major depressive disorder or generalized anxiety disorder is remission (ie, complete resolution of symptoms) rather than simply a response (eg, at least a > or = 50% improvement in symptoms). Despite treatment, incompletely remitted patients often have persistent social and/or functional impairment, and are particularly vulnerable to relapse. To optimize outcomes, it is important to continue to adjust and refine the treatment plan until there is resolution of residual depressive symptoms and normalization of social functioning. Thereafter, prophylactic therapy is indicated to lessen the risk of recurrence and/or chronicity. Contemporary treatment options include older medications such as tricyclic antidepressants, newer compounds, such as selective serotonin reuptake inhibitors, the serotonin and norepinephrine reuptake inhibitor, venlafaxine, and a number of other medications with novel mechanisms of action. Although it has been conventional to assume that all antidepressants are equally effective, evidence from a recent pooled analysis of data from eight double-blind, randomized, controlled clinical studies suggests that venlafaxine therapy may be associated with higher remission rates.