The clinical, psychosocial, and pharmacoeconomic ramifications of remission.

At an estimated cost of almost $50 billion a year, the socioeconomic burden of major depressive disorder is enormous. Although remission has been identified as the key goal of treatment, such treatment must be highly acceptable to patients, predictably effective, and carry minimal adverse effects. The cornerstone of depression management, remission can improve clinical status, functional ability, and quality of life for the patient while lowering utilization costs related to the disease and its comorbidities. Initially, the goals of therapy are to: (1) reduce and ultimately remove all signs and symptoms of the depressive syndrome; (2) restore occupational and psychosocial function to the asymptomatic state; and (3) achieve and maintain remission. Most patients can achieve these goals with the help of antidepressant medications, problem-focused psychotherapy, or a combination of the 2 methods. Following an initial assessment of the patient, treatment of depression has 3 phases: acute, continuation, and maintenance. Although adherence to treatment is crucial to successful treatment of depression, only about 25% to 35% of patients will achieve remission after 6 to 8 weeks of treatment; another 15% to 20% may remain depressed for months or years. Patients who achieve remission are much less likely to relapse than those who do not. Much debate has focused on the relative merits of prescribing selective serotonin reuptake inhibitors or venlafaxine. Results of a pooled analysis of 8 such comparative studies are presented.