Rather than merely being relieved of their negative symptoms, patients being treated for depression hope to attain optimism, self-confidence and a return to normal functioning, as goals of successful remission, according to a report in the January 2006 issue of the American Journal of Psychiatry.

Mental health professionals and researchers who conduct clinical trials of antidepressant treatment often consider improvement on measures of symptom severity, such as scores on the HAM-D and Montgomery-Asberg Depression Rating Scale (MADRS), as the primary goal of therapy, the authors explain. Return to normal functioning is rarely used to identify patients in remission.

Dr. Mark Zimmerman from Brown University School of Medicine, Providence, Rhode Island and colleagues surveyed 535 psychiatric outpatients diagnosed with major depression about the factors they considered important in defining remission from depression.

Among the 16 factors rated by the patients, the three most frequently judged to be very important in determining remission included features of positive mental health, such as optimism and self-confidence; a return to one's usual, normal self; and a return to their usual level of functioning, the authors report.

"The results of the present study suggest that depressed patients consider symptom resolution as only one factor in determining the state of remission," the investigators note. "In addition, patients indicated that the presence of positive features of mental health such as optimism, vigor, and self-confidence was a better indicator of remission than the absence of the symptoms of depression."

"It the primary goal of treatment for depression is to stop felling depressed," Zimmerman added, "we need to have a clear definition of what that means - both by the patient and the mental health professional."

"It is important to conduct a systematic and comprehensive evaluation of how a patient is feeling," Dr. Zimmerman stated. "By systematic, I believe that standardized instruments should be incorporated into clinical practice. By comprehensive, I mean that these assessments should go beyond symptom assessments."

Also, he said, "We are trying to get access to databases that have been collected by pharmaceutical companies to examine whether different cutoffs on the Hamilton will provide a more valid definition of remission."

SOURCE: American Journal of Psychiatry, January 2006.

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