What are the objectives for managing depression?

From the Guidelines

The primary objective for treating depression is to improve functional capacity, quality of life, and reduce symptoms, which can be achieved through a combination of cognitive behavioral therapy or second-generation antidepressants, as recommended by the American College of Physicians 1. When treating depression, the goals include:

• Reducing symptoms of depression, such as depressed mood, loss of pleasure or interest, and other symptoms that affect normal functioning
• Improving daily functioning and quality of life
• Preventing relapse and reducing the risk of hospitalizations
• Enhancing overall well-being and reducing suicidality Treatment options for depression include:
• Cognitive behavioral therapy, which has been shown to be effective in improving symptoms and functional capacity 1
• Second-generation antidepressants, such as SSRIs or SNRIs, which can be effective in reducing symptoms and improving quality of life
• Lifestyle modifications, such as regular exercise, adequate sleep hygiene, stress management techniques, social connection, and avoiding alcohol and recreational drugs The American College of Physicians recommends that clinicians select between either cognitive behavioral therapy or second-generation antidepressants to treat patients with major depressive disorder after discussing treatment effects, adverse effect profiles, cost, accessibility, and preferences with the patient 1. The treatment of depression can be characterized by three phases: acute, continuation, and maintenance, and relapse is defined as the return of depressive symptoms during the acute or continuation phases 1. Regular follow-up with healthcare providers is essential to monitor progress, adjust treatment as needed, and address any side effects or concerns.

From the FDA Drug Label

The pooled analyses of placebo-controlled trials in adults with MDD or other psychiatric disorders included a total of 295 short-term trials (median duration of 2 months) of 11 antidepressant drugs in over 77,000 patients. There was considerable variation in risk of suicidality among drugs, but a tendency toward an increase in the younger patients for almost all drugs studied The following symptoms, anxiety, agitation, panic attacks, insomnia, irritability, hostility, aggressiveness, impulsivity, akathisia (psychomotor restlessness), hypomania, and mania, have been reported in adult and pediatric patients being treated with antidepressants for major depressive disorder as well as for other indications, both psychiatric and nonpsychiatric Although a causal link between the emergence of such symptoms and either the worsening of depression and/or the emergence of suicidal impulses has not been established, there is concern that such symptoms may represent precursors to emerging suicidality

The objectives for depression treatment with antidepressants like fluoxetine 2 and venlafaxine 3 include:

• Monitoring patients for suicidality and unusual changes in behavior
• Assessing patients for precursors to emerging suicidality, such as anxiety, agitation, and impulsivity
• Screening patients for bipolar disorder before initiating treatment with an antidepressant
• Delaying the recurrence of depression through the use of antidepressants in maintenance trials
• Monitoring for serotonin syndrome, particularly when using serotonergic drugs concomitantly.

From the Research

Objectives for Depression

The primary objective for depression is to achieve remission, which is defined as virtually complete relief of symptoms and return to full functioning in all areas of life 4. This goal is recommended because residual symptoms are associated with a higher rate of relapse.

Key Objectives

• Achieve full remission within 8 weeks of therapy 4
• Manage relapse and prevent recurrence of depressive symptoms
• Improve treatment effectiveness through collaborative care programs, including systematic follow-up and outcome assessment 5
• Optimize the use of selective serotonin reuptake inhibitors (SSRIs) and other antidepressant medications to achieve the best possible outcomes 6

Factors Influencing Remission Rates

• Initial severity of depression 7
• Type of treatment 7
• Socio-economic factors, such as living alone, lower education, and unemployment 7
• Number of previous episodes of depression 7

Treatment Strategies

• Use of SSRIs, such as fluoxetine, citalopram, and escitalopram 5, 6
• Combination of psychotherapy and medication 5
• Collaborative care programs, including systematic follow-up and outcome assessment 5
• Close monitoring of treatment outcomes to improve the likelihood of success 5