Remission as the goal of treatment in major depressive disorder

The first step in initiating treatment is to establish the diagnosis, confirming MDD and being careful to rule out BPAD and comorbid anxiety or substance abuse/dependence disorders. Consideration should be given to the pathophysiology of the MDD, recognizing that current technology does not allow its identification in an individual patient. The pathophysiology must be considered in the selection of initial treatment; if an initial treatment has failed, treatment with a medication that has a different or expanded mechanism of action should be considered. Clinicians must also consider the importance of psychotherapy, where indicated, and listen to the feedback of their patients, tempering it with a measure of objectivity. Finally, clinicians must constantly query themselves as to whether there has been sufficient improvement in their patients with depression. It is the willingness to be appropriately aggressive in treating MDD that will ensure a timely, optimal outcome for their patients.