Clinical guidelines for establishing remission in patients with depression and anxiety.

Depression and anxiety exist together more often than as separate syndromes. Comorbid major depression substantially worsens the clinical outcome of patients with anxiety disorders such as panic disorder, social phobia, and generalized anxiety disorder. Although previous treatment guidelines have addressed depression and anxiety separately, we have developed guidelines that more closely approximate the types of patients seen in clinical practice. These recommendations focus on scales to measure all symptoms (anxiety and depression) and propose full remission and functional recovery as the goal of treatment. Objective guidelines for remission include maintaining the Hamilton Rating Scale for Depression total score at < or = 7 and the Hamilton Rating Scale for Anxiety total score at 7 to 10 or even lower--rigorous, challenging, but appropriate goals to restore patients to a normal functional state.