Depression is considered a chronic and recurrent illness. This has been proven with the finding of long-term follow-up studies of psychiatric outpatients. Among depressed patients treated by specialists, up to 50% do not recover by 6 months and 10% show a chronic course. Among those who recover, the risk of relapse is 40% or more over 2 years and exceeds 80% if the period of observation is extended to 15 years.
One of the reasons why Major Depressive Disorder (MDD) is turning out to be chronic and recurrent is that patients tend not to stop taking the medications prescribed by their doctor. Many stop their medications even if the medical doctor has not told them to do so. A common reason people stopped the medications was due to unpleasant side effects. This problem which is inherent in the nature of the drug needs to be addressed by both the medical community and the pharmaceutical industry. If the antidepressants are largely free from intolerable side effects, you will probably keep on using the drug for as long as it is needed, and the prevalence of chronicity and recurrence of MDD could be reduced.
MDD could be reduced.
In another study, it was revealed that when you do not respond to a medication or combination of medications for MDD within, or after, two weeks of treatment, then your chance of having a stable response or stable remission is very small. It is thus necessary that as much as possible your medical doctor needs to change your medical management if your current treatment has not been working. Chronicity and recurrence of your MDD will take place if you insist on using a drug that does not work for you.
When your MDD has psychotic features your doctor will need to monitor you closely. It has been determined and found that psychotic symptoms during major depressive episodes increase the risk of completed suicide after serious suicide attempts. For this reason, the quality of your treatment needs to be improved to prevent the consummation of your suicide.
Futuristic and evolving management of Major Depressive Disorder
MDD is a complex and frequent psychiatric condition that poses challenges to both you and your physician. It is complex because if you follow the diagnostic criteria as mentioned and defined in the preceding, you will have a number of different combinations and each combination presents different kinds of clinical manifestations.
Considering that each combination presents as a different disease, for you and for the other patients to get well, the treatment needs to be highly individualized. Therefore, each of you will need a different kind of medicine. It is now recognized that psychiatric symptoms correlate well with a particular malfunctioning brain circuits. Thus, understanding your symptom profile is a key to individualizing treatment because different symptoms may reflect differences in underlying neuropathology, including differences in neurotransmitter-related abnormalities. Knowing this, your physician could properly select the most appropriate medications that have the mechanism of action appropriate for you and for other patients. This will lead to highly individualized treatment.
In evaluating the effectiveness of your current medications, there are four levels of treatment outcomes as shown in
Treatment outcomes and criteria
Several decades ago the criteria for successful treatment of MDD was the achievement of greater than 50% reduction in total symptom severity—classified as “response” in Table above. With this criterion, however, it was obvious that significant residual symptoms remain that you are predisposed to experience recurrence, chronicity, and suicidality. To avoid this, over the last 3 decades, the desired outcome for the treatment of MDD has shifted from “response” to “remission” as shown in the table above.
For you to have achieved remission, you need to experience the following outcomes:
- Absence of symptoms of depression
- Presence of positive mental health (such as optimism, vigor, self-confidence)
- Feeling like your usual, normal self
- Return to usual level of functioning at work, home, or school
- Feeling in emotional control
- Participating in, and enjoying, relationships with family and friends