Improving the chance of recovery from the short- and long-term consequences of depression

Major depressive disorder (MDD) is a common, chronic disorder that requires long-term management. Although effective treatments are available, MDD frequently remains undiagnosed. Furthermore, once recognized, treatment duration and dosage are often inadequate and adherence to medication is often poor. However, adequate acute phase treatment of MDD is essential to reduce symptomatology, and improve quality of life and the clinical course. After remission, treatment should be continued for 4-9 months to consolidate the remission and prevent relapse. For patients who do not respond adequately to their initial antidepressant therapy, switching or augmentation of therapy may be necessary. Many patients suffer residual symptomatology, even when classified as being in remission. In addition to the suffering and impairment that this causes, residual symptomatology is associated with a high rate of relapse. Clinicians should strive to achieve asymptomatic recovery both in terms of core symptomatology and psychosocial disability. This requires appropriate treatment at therapeutic doses for a sufficient duration; education and support to promote patient compliance with treatment; and regular monitoring and prompt intervention for patients with symptoms that persist even at subsyndromal levels. In conclusion, there remains considerable scope for improving the identification, treatment and management of patients with MDD.