From the Guidelines
For patients with Major Depressive Disorder (MDD) in partial remission, the most effective treatment approach is to continue the current antidepressant medication and incorporate psychotherapy, such as cognitive behavioral therapy (CBT) or interpersonal therapy, to achieve full remission. This approach is supported by the most recent and highest quality study, which recommends continuing antidepressant medication for at least 6-12 months after achieving full remission to prevent relapse 1. Common medications include SSRIs (like sertraline 50-200mg daily, escitalopram 10-20mg daily), SNRIs (like venlafaxine 75-225mg daily), or other classes based on patient response and side effect profile.
Key Considerations
- Augmentation strategies, such as adding bupropion (150-300mg daily), an atypical antipsychotic like aripiprazole (2-15mg daily), or mood stabilizers, should be considered if full remission is not achieved 1.
- Psychotherapy, particularly CBT or interpersonal therapy, should be incorporated alongside medication to achieve full remission 1.
- Regular monitoring every 2-4 weeks initially, then every 1-3 months once stable, is essential to track symptoms using standardized scales like PHQ-9 1.
- Lifestyle modifications, including regular exercise, good sleep hygiene, stress management, and social support, are important complementary approaches to achieve full symptom resolution and functional recovery 1.
Treatment Options
- Continue current antidepressant medication for at least 6-12 months after achieving full remission to prevent relapse 1.
- Incorporate psychotherapy, such as CBT or interpersonal therapy, to achieve full remission 1.
- Consider augmentation strategies, such as adding bupropion, an atypical antipsychotic, or mood stabilizers, if full remission is not achieved 1.
- Bright light therapy may be recommended for patients with mild to moderate MDD, regardless of seasonal pattern or seasonal component 1.
- rTMS may be considered for patients with MDD who have shown partial or no response to 2 or more adequate pharmacologic treatment trials 1.
From the FDA Drug Label
It is generally agreed that acute episodes of major depressive disorder require several months or longer of sustained pharmacologic therapy beyond response to the acute episode Systematic evaluation of sertraline has demonstrated that its antidepressant efficacy is maintained for periods of up to 44 weeks following 8 weeks of initial treatment at a dose of 50 to 200 mg/day
The FDA drug label does not provide specific guidance on the management of Major Depressive Disorder (MDD) in partial remission. However, it suggests that sustained pharmacologic therapy is necessary for several months or longer beyond the initial response to the acute episode. The dose of sertraline needed for maintenance treatment is not established, but it is recommended to periodically reassess patients to determine the need for maintenance treatment.
- Key points:
- Sustained pharmacologic therapy is necessary for several months or longer
- Dose of sertraline needed for maintenance treatment is not established
- Periodic reassessment is recommended to determine the need for maintenance treatment
- Sertraline 2 and duloxetine 3 have demonstrated efficacy in the treatment of MDD, but the labels do not provide specific guidance on partial remission
- Fluoxetine 4 also has demonstrated efficacy in the treatment of MDD, but the label does not provide specific guidance on partial remission
From the Research
Treatment Options for MDD in Partial Remission
- Psychotherapy is associated with lower depressive symptom severity at post-treatment (Hedges' g=0.50; 95% CI 0.23 to 0.76) and superior remission rates at post-treatment (OR 2.57; 95% CI 1.71 to 3.87) and follow-up 6 months or longer (OR 1.75; 95% CI 1.21 to 2.53) 5
- There is limited evidence for the effectiveness of pharmacotherapy in treating MDD in partial remission, with no substantial differences in efficacy and safety among second-generation antidepressants 6, 7
- Global functioning is lower in patients with MDD in full or partial remission compared with healthy control individuals (SMD -2.00,95% CI: -0.9 to -3.03) 8
Efficacy and Safety of Specific Treatments
- Duloxetine is an effective treatment option for acute-phase MDD, with a tolerability profile similar to other second-generation antidepressants 7
- Fluoxetine, sertraline, and ECT have demonstrated a positive index of change in consecutive periods, indicating their effectiveness in treating MDD 9
- The popularity of SSRI peaked between 1998 and 2002, and has remained high since then, while the popularity of ECT has sustained and the newer neurostimulation therapies are gaining momentum 9