Remission and recovery in depression treatment

The array of drugs available for the treatment of Major Depressive Disorder (MDD) continues to increase. Treatment emphasis has shifted away from an "adequate" response to an antidepressant medication, moving toward the goal of full symptomatic remission and return to normal function. This has been aided by the advent of treatment algorithms or guidelines. These algorithms provide a comprehensive plan for addressing MDD, starting with the simplest, safest treatment and methodically progressing towards more complicated treatment if the patient proves to be treatment-refractory. Clinicians may choose to switch medications if a patient shows no response, and partial responders may continue a given treatment, adding an augmenting agent. Remission rates may be higher for those drugs that act on both serotonin and norepinephrine receptors. Whether a dual action medication or a combination of drugs with differing mechanisms of action, the resultant synergistic effects are often beneficial. Difficulties remain in treating patients with MDD, including inadequate treatment and poor patient adherence. Not all patients are helped with the currently available medications. Exciting work is being done on brain-derived neurotrophic factor (BDNF) and peptide neurotransmitters known as neurokinins. Other current research efforts include monoaminergic modulators such as beta agonists, second messenger systems, 5-HT1A agonists, partial agonists and antagonists, dual reuptake blocks of serotonin and dopamine, serotonin 1D antagonists (possibly producing a rapid-onset antidepressant), neurokinin antagonists, and other novel neurotransmitter mechanisms. Ideally, new treatments for MDD should be effective for most people and be quick acting, allowing more patients to reach full, sustained remission and functional recovery.