Study results suggest that sustained remission of major depressive disorder requires treatment of all symptoms until they are undetectable, and make a case for linking symptoms with malfunctioning brain circuits and neurotransmitters to find a targeted approach for treating residual symptoms.
A review in the American Journal of Medicine suggests that sustained remission of major depressive disorder (MDD) requires treatment of all symptoms until they are undetectable, and makes a case for linking symptoms with malfunctioning brain circuits and neurotransmitters to find a targeted approach for treating residual symptoms.
The authors note that dealing with “residual” symptoms, which can include anxiety and insomnia, among others, is not a trivial issue. Failing to treat these symptoms can lead to continued functional impairment, a higher risk of relapse, a shorter course of well intervals, fewer symptom-free weeks, and increased risk of suicide. Yet, the challenge of identifying and treating residual symptoms is immense. For MDD, which is defined as depressed mood or apathy/loss of interest plus ≥4 additional symptoms, there are more than 60 forms of the condition given the various possible combinations of symptoms.
The review looks at many of those combinations, residual symptoms, current pharmacologic and nonpharmacologic treatments for each, and the latest evidence on the neurobiology behind MDD and its major symptoms. Among the more interesting aspects of the review:
Looking ahead, the review authors noted, “Applying neurobiology principles to treatment selections may assist physicians in determining whether to switch antidepressants, add another antidepressant medication, or augment antidepressant therapy with another pharmacologic agent or a nonpharmacologic treatment such as psychotherapy. Throughout a treatment course for major depressive disorder, antidepressant medications must be given for a sufficient duration at a sufficient dose and patients monitored for response to adverse events with treatment and psychiatric and medical comorbidities. Patients with residual symptoms or treatment-resistant depression can achieve complete remission of their symptoms and regain functionality.”