Streven naar remissie van depressie door een betere en bredere aanpak van de symptomen

The first part of this paper outlines the scale, impact and current management of major depressive disorder. Major depressive disorder is a huge public health problem, and despite the availability of a range of effective antidepressants and approaches to therapy, many patients fail to achieve remission, or if they do, they go on to suffer relapse or recurrence. Partial remission leaves patients experiencing residual symptoms, with a greater risk of relapse, more severe, chronic disease, impaired psychosocial functioning, a lower health-related quality of life, and an increased risk of mortality. This background provides the context for exploration of the traditional definition of remission, and it is suggested that a broader definition of remission would be a better guide to therapy. The main point of this paper is the proposal for an alternative definition of remission that incorporates positive therapeutic outcomes in four perspectives; psychodynamic, cognitive, biological and functional. Barriers to the application of a broader definition of remission in the clinic are explored briefly, and the need for specific, practical multi-axial instruments for use in MDD is acknowledged. Broad remission is more likely to be achieved using antidepressants that address a wider range of symptoms. It is also important to continue therapy beyond the acute stage into continuation, and possibly maintenance therapy, if complete remission is to be achieved and maintained in the long term.