Posted by River1924 on January 12, 2006, at 1:34:27
NEW YORK (Reuters Health) Jan 11 - More than merely relief from negative symptoms, patients being treated for depression hope for positive mental health and a return to normal functioning -- as measures of successful remission -- according to a report in the January 2006 issue of the American Journal of Psychiatry.
Antidepressant efficacy trials often rely on measures of symptom severity such as the HAM-D and Montgomery-Asberg Depression Rating Scale (MADRS), the authors explain, but normalization of function 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 with major depression as to what 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 the presence of features of positive mental health such as optimism and self-confidence; a return to one's usual, normal self; and a return to 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 conclude. "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."
"Consequently," the authors add, "we recommend that studies comparing the respective validity of alternative conceptualizations of remission focus on prognosis."
"It is important to conduct a systematic and comprehensive evaluation of how a patient is feeling," Dr. Zimmerman told Reuters Health. "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 by virtue of the ability to predict future relapse."
Am J Psychiatry 2006;163:148-150.
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