Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2008;10(4):377-84.
doi: 10.31887/DCNS.2008.10.4/mhtrivedi.

Treatment strategies to improve and sustain remission in major depressive disorder

Madhukar H Trivedi  1 , Ella J Daly
Affiliations
Review

Treatment strategies to improve and sustain remission in major depressive disorder

Madhukar H Trivedi et al. Dialogues Clin Neurosci. 2008.

Abstract
in English, Spanish, French

Major depressive disorder (MDD) is an often chronic, recurrent illness affecting large numbers of the general population. In recent years, the goal of treatment for MDD has moved from mere symptomatic response to that of full remission (i.e., minimal/no residual symptoms). The recent Sequenced Treatment Alternatives to Relieve Depression (STAR*D) trial showed that even with systematic measurement-based treatment, approximately one third of patients reach full remission after one treatment trial, with only two thirds reaching remission after four treatment trials. Treatment-resistant depression (TRD) is therefore a common problem in the treatment of MDD, with 60% to 70% of all patients meeting the criteria for TRD. Given the huge burden of major depressive illness, the low rate of full recovery remains suboptimal. The following article reports on some current treatment strategies available to improve rates of, and to sustain, remission in MDD.

El trastorno depresivo mayor (TDM) con frecuencia es una enfermedad crónica y recurrente que afecta a un gran número de personas en la población general. En años recientes, el objetivo del tratamiento del TDM ha cambiado desde la mera respuesta sintomática a la remisión total (por ej. síntomas mínimos/ no residuales).

El reciente estudio STAR*D (Sequenced Treatment Alternatives to Relieve Depression) demostró que incluso con un tratamiento basado en la medición sistemática, aproximadamente un tercio de los pacientes alcanza la remisión completa después de un ensayo terapéutico, y solo dos tercios alcanzan la remisión después de cuatro ensayos terapéuticos. La depresión resistente al tratamiento (DRT) es por lo tanto un problema común en el tratamiento del TDM, y el 60% a 70% de todos los pacientes reúne los criterios para DRT. Considerando la enorme carga de la enfermedad depresiva mayor, el bajo porcentaje de recuperación compléta persiste subóptimo. El siguiente artículo revisa algunas estrategias terapéutícas actuales disponibles para mejorar los porcentajes tanto de remisión como del mantenimiento de ésta en el TDM.

Les troubles dépressifs majeurs (TDM) constituent une maladie souvent chronique et récurrente qui touche un grand nombre de sujets dans la population générale. Ces dernières années, l'objectif du traitement des TDM est passé d'une simple réponse symptomatique à une rémission totale (c'est-à-dire, symptômes résiduels absents ou minimaux).

L'étude récente STAR*D (Sequence Treatment Alternatives to Relieve Depression) a montré que même avec un traitement systématique basé sur des mesures, à peu près 1/3 des patients sont en rémission totale après un essai thérapeutique contre 2/3 après 4 essais. La dépression résistance au traitement (DRT) est donc un problème fréquent, avec 60 à 70 % de l'ensemble des patients en présentant les critères. Compte tenu du handicap énorme que représentent les TDM, le faible taux de guérison totale reste sous-optimal. L'article qui suit expose certaines stratégies thérapeutiques actuelles capables d'améliorer et de maintenir les taux de rémission dans les TDM,

PubMed Disclaimer

References

    1. Institute of Medicine. Priority Areas for National Action Transforming Health Care Quality. Washington, DC: National Academy Press; 2003 - PubMed
    1. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, 4th ed. Text Revision. Washington DC: American Psychiatric Press; 2000
    1. World Health Organization. World Health Report 2001. Mental Health: New Understanding, New Hope. Geneva, Switzerland: World Health Organization; 2001
    1. Rush AJ., Trivedi MH., Wisniewski SR., et al. Bupropion-SR, sertraline, or venlafaxine-XR after failure of SSRIs for depression. N Engl J Med. 2006;354:1231–1242. - PubMed
    1. Trivedi MH., Rush AJ., Wisniewski SR., et al. Evaluation of outcomes with citalopram for depression using measurement-based care in STAR*D: implications for clinical practice. Am J Psychiatry. 2006;163:28–40. - PubMed

Substances