Achieving adequate outcomes in geriatric depression: standardized criteria for remission

In the management of late-life depression, a major set of issues concerns the terms or language used to describe the course of illness and response to treatment. There appear to be considerable advantages in the application of standardized remission criteria. If one is primarily concerned with symptomatic remission and the resolution of a single or initial episode of depression, then a moderately strict criterion is sufficient, for example, Hamilton Rating Scale for Depression (HRSD) < or = 10. However, as the goal of treatment is to achieve complete recovery, which may reduce the risk for either relapse or recurrence, then there may be a strong advantage in applying a more stringent remission criterion such as HRSD < or = 6 or 7. The characteristics of the response pattern (ie, trajectory of clinical course) also can provide important prognostic information. Such pattern characteristics can be modeled with newer statistical methods, which in turn can better inform the course of future treatment. Finally, there is growing recognition that standardized remission criteria can be valuable for establishing treatment guidelines for late-life depression, as well as for educating clinicians and consumers.