From the Guidelines
No, a diagnosis of Major Depressive Disorder (MDD) in complete remission is not always given to someone who has had one depressive episode. This diagnosis is only appropriate when a person has previously met the full criteria for MDD but currently has no significant signs or symptoms of the disorder for at least two consecutive months. The person must have experienced a depressive episode characterized by at least five symptoms (including depressed mood or loss of interest/pleasure) present for at least two weeks, causing significant distress or impairment. After recovery, clinicians specify the current clinical status using terms like "in partial remission" (some symptoms remain but full criteria are not met) or "in complete remission" (no significant symptoms for at least two months). For a single episode, the diagnosis would be "Major Depressive Disorder, Single Episode, In Complete Remission." This specification helps clinicians track the course of illness and informs treatment decisions, as those with previous episodes have higher risk of recurrence and may benefit from maintenance treatment even when symptoms have resolved, as supported by the American College of Physicians recommendations 1.
According to the most recent and highest quality study, the probability of a recurrent episode is approximately 50% after a first episode of depression 1. Therefore, it is crucial to continue treatment for 4 to 9 months after a satisfactory response in patients with a first episode of major depressive disorder, as recommended by the American College of Physicians 1.
Some key points to consider when diagnosing and treating MDD include:
- The course of depression can be characterized by three phases: acute, continuation, and maintenance 1
- Relapse is defined as the return of depressive symptoms during the acute or continuation phases, while recurrence is defined as the return of depressive symptoms during the maintenance phase 1
- Clinicians should assess patient status, therapeutic response, and adverse effects of antidepressant therapy on a regular basis beginning within 1 to 2 weeks of initiation of therapy 1
- The American College of Physicians recommends that clinicians modify treatment if the patient does not have an adequate response to pharmacotherapy within 6 to 8 weeks of the initiation of therapy for major depressive disorder 1
From the Research
Diagnosis of Major Depressive Disorder (MDD) in Complete Remission
- A diagnosis of Major Depressive Disorder (MDD) in complete remission is not always given to someone who has had one depressive episode 2, 3.
- The diagnosis of MDD in complete remission depends on various factors, including the severity and duration of the depressive episode, as well as the presence of any residual symptoms 4.
- According to the DSM-IV, a person can be diagnosed with MDD if they have experienced at least one major depressive episode in their lifetime 3.
- However, the diagnosis of MDD in complete remission requires that the individual has not experienced any significant depressive symptoms for a certain period, usually at least 2 months 2.
Treatment and Remission
- Treatment for MDD can include a combination of psychotherapy, such as cognitive-behavioral therapy (CBT), and medication, such as selective serotonin reuptake inhibitors (SSRIs) 5, 6.
- Remission rates for MDD can vary depending on the treatment approach, with some studies suggesting that CBT can be an effective treatment for achieving remission 3, 6.
- The use of SSRIs, such as escitalopram, has also been shown to be effective in achieving remission in patients with MDD 5.
Factors Influencing Diagnosis and Treatment
- The presence of anxiety symptoms can predict poorer outcomes for patients with MDD, regardless of the treatment approach 2.
- The order in which CBT and medication are sequentially combined does not appear to affect outcomes 2.
- Patient preference for psychotherapy over pharmacotherapy can also influence treatment decisions, with some patients preferring CBT over medication 6.