Plotting the course to remission: the search for better outcomes in the treatment of depression.

Depression includes a wide range of symptoms that can impair a person's psychosocial and physical functioning. This impairment can lead to decreased productivity, increased health care utilization, alcohol and substance abuse, and an increased risk of suicide. While the treatment of depression has significantly advanced over the past 30 years, there is still room for improvement. Full remission of depressive symptoms is often elusive, and many patients never achieve full relief from their depression despite being regarded as responders to antidepressant treatment. Current treatments for depression tend to focus on emotional symptoms, not the physical and anxious symptoms also associated with depression. However, the physical and anxious symptoms of depression can be serious and sometimes more prominent than the emotional symptoms of depression, especially among special populations such as women. New treatment strategies, such as dual-acting agents and the combination of pharmacotherapy and psychotherapy, target the emotional and anxious symptoms of depression as well as symptoms associated with pain. In order to increase response and remission, depression should be seen as an illness comprising not only emotional symptoms but physical and anxious symptoms as well.