Top Goal in the Acute Phase of Major Depressive Disorder
The top goal in the acute phase of major depressive disorder is patient safety, particularly suicide risk assessment and prevention. 1
Understanding the Acute Phase
The acute phase of depression is the initial treatment period lasting 6-12 weeks, during which the primary objective is to achieve symptom remission while ensuring the patient remains safe from self-harm. 1 This phase is distinct from the continuation phase (4-9 months) and maintenance phase (≥1 year). 2
Why Patient Safety Takes Priority
During the acute phase, suicide risk assessment and monitoring must be the foremost concern before and during any therapeutic intervention. 1 This is particularly critical because:
- Assessment for suicidality should occur within 1-2 weeks of treatment initiation and continue throughout the acute phase 1
- Patients with severe depression and high-risk features require immediate intervention with close monitoring regardless of symptom count 1
- The initial treatment period carries heightened risk as patients may gain energy before mood improves 1
Common Pitfall to Avoid
The most dangerous error is failing to monitor for suicidality, especially during the initial treatment period. 1 Clinicians must not become so focused on symptom reduction that they overlook ongoing suicide risk assessment, which remains paramount throughout the entire acute phase.
Secondary Goals After Safety is Established
Once safety is assured, the acute phase goals include:
- Achieving symptom remission (≥50% reduction in severity scores) 1
- Restoring baseline functional capacity 3
- Preventing progression to treatment-resistant depression through adequate dosing and duration (minimum 4-6 weeks for therapeutic effects) 1
Treatment Context
While treatment selection (CBT, second-generation antidepressants, or combination therapy) is important, these decisions are secondary to ensuring patient safety. 4 The American College of Physicians recommends monotherapy with either cognitive behavioral therapy or second-generation antidepressants for moderate to severe MDD, but only after safety has been established as the primary concern. 4