Report by the ACNP Task Force on response and remission in major depressive disorder

A. John Rush, Helena C. Kraemer, Harold A. Sackeim, Maurizio Fava, Madhukar H. Trivedi, Ellen Frank, Philip T. Ninan, Michael E. Thase, Alan J. Gelenberg, David J. Kupfer, Darrel A. Regier, Jerrold F. Rosenbaum, Oakley Ray, Alan F. Schatzberg

Research output: Contribution to journalArticle

401 Citations (Scopus)

Abstract

This report summarizes recommendations from the ACNP Task Force on the conceptualization of remission and its implications for defining recovery, relapse, recurrence, and response for clinical investigators and practicing clinicians. Given the strong implications of remission for better function and a better prognosis, remission is a valid, clinically relevant end point for both practitioners and investigators. Not all depressed patients, however, will reach remission. Response is a less desirable primary outcome in trials because it depends highly on the initial (often single) baseline measure of symptom severity. It is recommended that remission be ascribed after 3 consecutive weeks during which minimal symptom status (absence of both sadness and reduced interest/pleasure along with the presence of fewer than three of the remaining seven DSM-IV-TR diagnostic criterion symptoms) is maintained. Once achieved, remission can only be lost if followed by a relapse. Recovery is ascribed after at least 4 months following the onset of remission, during which a relapse has not occurred. Recovery, once achieved, can only be lost if followed by a recurrence. Day-to-day functioning and quality of life are important secondary end points, but they were not included in the proposed definitions of response, remission, recovery, relapse, or recurrence. These recommendations suggest that symptom ratings that measure all nine criterion symptom domains to define a major depressive episode are preferred as they provide a more certain ascertainment of remission. These recommendations were based largely on logic, the need for internal consistency, and clinical experience owing to the lack of empirical evidence to test these concepts. Research to evaluate these recommendations empirically is needed.

Original languageEnglish (US)
Pages (from-to)1841-1853
Number of pages13
JournalNeuropsychopharmacology
Volume31
Issue number9
DOIs
StatePublished - Sep 12 2006

Fingerprint

Major Depressive Disorder
Advisory Committees
Recurrence
Research Personnel
Pleasure
Status Epilepticus
Diagnostic and Statistical Manual of Mental Disorders
Quality of Life
Research

Keywords

  • Depression
  • Recovery
  • Recurrence
  • Relapse
  • Remission
  • Response

ASJC Scopus subject areas

  • Pharmacology

Cite this

Rush, A. J., Kraemer, H. C., Sackeim, H. A., Fava, M., Trivedi, M. H., Frank, E., ... Schatzberg, A. F. (2006). Report by the ACNP Task Force on response and remission in major depressive disorder. Neuropsychopharmacology, 31(9), 1841-1853. https://doi.org/10.1038/sj.npp.1301131

Report by the ACNP Task Force on response and remission in major depressive disorder. / Rush, A. John; Kraemer, Helena C.; Sackeim, Harold A.; Fava, Maurizio; Trivedi, Madhukar H.; Frank, Ellen; Ninan, Philip T.; Thase, Michael E.; Gelenberg, Alan J.; Kupfer, David J.; Regier, Darrel A.; Rosenbaum, Jerrold F.; Ray, Oakley; Schatzberg, Alan F.

In: Neuropsychopharmacology, Vol. 31, No. 9, 12.09.2006, p. 1841-1853.

Research output: Contribution to journalArticle

Rush, AJ, Kraemer, HC, Sackeim, HA, Fava, M, Trivedi, MH, Frank, E, Ninan, PT, Thase, ME, Gelenberg, AJ, Kupfer, DJ, Regier, DA, Rosenbaum, JF, Ray, O & Schatzberg, AF 2006, 'Report by the ACNP Task Force on response and remission in major depressive disorder', Neuropsychopharmacology, vol. 31, no. 9, pp. 1841-1853. https://doi.org/10.1038/sj.npp.1301131
Rush, A. John ; Kraemer, Helena C. ; Sackeim, Harold A. ; Fava, Maurizio ; Trivedi, Madhukar H. ; Frank, Ellen ; Ninan, Philip T. ; Thase, Michael E. ; Gelenberg, Alan J. ; Kupfer, David J. ; Regier, Darrel A. ; Rosenbaum, Jerrold F. ; Ray, Oakley ; Schatzberg, Alan F. / Report by the ACNP Task Force on response and remission in major depressive disorder. In: Neuropsychopharmacology. 2006 ; Vol. 31, No. 9. pp. 1841-1853.
@article{f8a7f3f596d842a78845052f3926f2e1,
title = "Report by the ACNP Task Force on response and remission in major depressive disorder",
abstract = "This report summarizes recommendations from the ACNP Task Force on the conceptualization of remission and its implications for defining recovery, relapse, recurrence, and response for clinical investigators and practicing clinicians. Given the strong implications of remission for better function and a better prognosis, remission is a valid, clinically relevant end point for both practitioners and investigators. Not all depressed patients, however, will reach remission. Response is a less desirable primary outcome in trials because it depends highly on the initial (often single) baseline measure of symptom severity. It is recommended that remission be ascribed after 3 consecutive weeks during which minimal symptom status (absence of both sadness and reduced interest/pleasure along with the presence of fewer than three of the remaining seven DSM-IV-TR diagnostic criterion symptoms) is maintained. Once achieved, remission can only be lost if followed by a relapse. Recovery is ascribed after at least 4 months following the onset of remission, during which a relapse has not occurred. Recovery, once achieved, can only be lost if followed by a recurrence. Day-to-day functioning and quality of life are important secondary end points, but they were not included in the proposed definitions of response, remission, recovery, relapse, or recurrence. These recommendations suggest that symptom ratings that measure all nine criterion symptom domains to define a major depressive episode are preferred as they provide a more certain ascertainment of remission. These recommendations were based largely on logic, the need for internal consistency, and clinical experience owing to the lack of empirical evidence to test these concepts. Research to evaluate these recommendations empirically is needed.",
keywords = "Depression, Recovery, Recurrence, Relapse, Remission, Response",
author = "Rush, {A. John} and Kraemer, {Helena C.} and Sackeim, {Harold A.} and Maurizio Fava and Trivedi, {Madhukar H.} and Ellen Frank and Ninan, {Philip T.} and Thase, {Michael E.} and Gelenberg, {Alan J.} and Kupfer, {David J.} and Regier, {Darrel A.} and Rosenbaum, {Jerrold F.} and Oakley Ray and Schatzberg, {Alan F.}",
year = "2006",
month = "9",
day = "12",
doi = "10.1038/sj.npp.1301131",
language = "English (US)",
volume = "31",
pages = "1841--1853",
journal = "Neuropsychopharmacology",
issn = "0893-133X",
publisher = "Nature Publishing Group",
number = "9",

}

TY - JOUR

T1 - Report by the ACNP Task Force on response and remission in major depressive disorder

AU - Rush, A. John

AU - Kraemer, Helena C.

AU - Sackeim, Harold A.

AU - Fava, Maurizio

AU - Trivedi, Madhukar H.

AU - Frank, Ellen

AU - Ninan, Philip T.

AU - Thase, Michael E.

AU - Gelenberg, Alan J.

AU - Kupfer, David J.

AU - Regier, Darrel A.

AU - Rosenbaum, Jerrold F.

AU - Ray, Oakley

AU - Schatzberg, Alan F.

PY - 2006/9/12

Y1 - 2006/9/12

N2 - This report summarizes recommendations from the ACNP Task Force on the conceptualization of remission and its implications for defining recovery, relapse, recurrence, and response for clinical investigators and practicing clinicians. Given the strong implications of remission for better function and a better prognosis, remission is a valid, clinically relevant end point for both practitioners and investigators. Not all depressed patients, however, will reach remission. Response is a less desirable primary outcome in trials because it depends highly on the initial (often single) baseline measure of symptom severity. It is recommended that remission be ascribed after 3 consecutive weeks during which minimal symptom status (absence of both sadness and reduced interest/pleasure along with the presence of fewer than three of the remaining seven DSM-IV-TR diagnostic criterion symptoms) is maintained. Once achieved, remission can only be lost if followed by a relapse. Recovery is ascribed after at least 4 months following the onset of remission, during which a relapse has not occurred. Recovery, once achieved, can only be lost if followed by a recurrence. Day-to-day functioning and quality of life are important secondary end points, but they were not included in the proposed definitions of response, remission, recovery, relapse, or recurrence. These recommendations suggest that symptom ratings that measure all nine criterion symptom domains to define a major depressive episode are preferred as they provide a more certain ascertainment of remission. These recommendations were based largely on logic, the need for internal consistency, and clinical experience owing to the lack of empirical evidence to test these concepts. Research to evaluate these recommendations empirically is needed.

AB - This report summarizes recommendations from the ACNP Task Force on the conceptualization of remission and its implications for defining recovery, relapse, recurrence, and response for clinical investigators and practicing clinicians. Given the strong implications of remission for better function and a better prognosis, remission is a valid, clinically relevant end point for both practitioners and investigators. Not all depressed patients, however, will reach remission. Response is a less desirable primary outcome in trials because it depends highly on the initial (often single) baseline measure of symptom severity. It is recommended that remission be ascribed after 3 consecutive weeks during which minimal symptom status (absence of both sadness and reduced interest/pleasure along with the presence of fewer than three of the remaining seven DSM-IV-TR diagnostic criterion symptoms) is maintained. Once achieved, remission can only be lost if followed by a relapse. Recovery is ascribed after at least 4 months following the onset of remission, during which a relapse has not occurred. Recovery, once achieved, can only be lost if followed by a recurrence. Day-to-day functioning and quality of life are important secondary end points, but they were not included in the proposed definitions of response, remission, recovery, relapse, or recurrence. These recommendations suggest that symptom ratings that measure all nine criterion symptom domains to define a major depressive episode are preferred as they provide a more certain ascertainment of remission. These recommendations were based largely on logic, the need for internal consistency, and clinical experience owing to the lack of empirical evidence to test these concepts. Research to evaluate these recommendations empirically is needed.

KW - Depression

KW - Recovery

KW - Recurrence

KW - Relapse

KW - Remission

KW - Response

UR - http://www.scopus.com/inward/record.url?scp=33747339984&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=33747339984&partnerID=8YFLogxK

U2 - 10.1038/sj.npp.1301131

DO - 10.1038/sj.npp.1301131

M3 - Article

C2 - 16794566

AN - SCOPUS:33747339984

VL - 31

SP - 1841

EP - 1853

JO - Neuropsychopharmacology

JF - Neuropsychopharmacology

SN - 0893-133X

IS - 9

ER -