Strategies for achieving full remission when first-line antidepressants are not enough

Remission rates for patients with major depressive disorder are discouragingly low. Even when first-line treatment is administered at an adequate dose for a sufficient duration, approximately two-thirds of patients will fail to achieve remission, and many who remit have residual symptoms. Clinicians must assess problems with the first treatment and select the most appropriate second-line treatment based on patient preference, clinical judgment, and any comorbid conditions. Strategies like implementing psychotherapy, switching agents, or augmenting antidepressants may help patients achieve remission. Patients may also require adjunctive therapy to target common residual symptoms such as fatigue or insomnia.