Evidence-based strategies for achieving and sustaining full remission in depression: focus on metaanalyses

The goal of therapy in the management of patients with major depressive disorder is to achieve and sustain remission. Extensive data on strategies to achieve remission have been published, and more recently, many of these data have been subject to systematic review and metaanalyses. This review compares data from metaanalyses and more recent trials on some of the therapies that may help to achieve remission. Strategies that have demonstrated improved rates of full remission in the treatment of depression include venlafaxine as initial antidepressant therapy, which has been shown to provide higher rates of remission when compared with serotonin reuptake inhibitors and tricyclic antidepressants. For patients who do not respond to initial medication treatment, treatments such as psychotherapy, exercise, light therapy, alternative medicines, and counselling have demonstrated benefits over placebo and may enhance remission rates when used in combination with antidepressants. Preventing relapse and sustaining the fully remitted state over the long term is also important in the management of depression. Continuing antidepressant therapy has been associated with excellent long-term outcomes for many patients. Randomized controlled clinical trials conducted in the last 5 years provide very good evidence to show that achieving and sustaining the fully remitted state is an attainable goal in the management of patients with depression.