Strategies to enhance the therapeutic efficacy of antidepressants: targeting residual symptoms

Abstract

Major depressive disorder (MDD) is an illness of great morbidity that affects many people across the world. The current goal for treatment of MDD is to achieve remission (i.e., no depressive symptoms). However, despite scientific advances in the treatment for MDD, antidepressants as first-line agents yield only modest remission rates. In fact, a recent study indicated that only one out of three subjects who received a standard, first-line antidepressant attained remission. Not achieving remission from depressive symptoms increases the risk of a more chronic and debilitating course of illness with frequent recurrences. Although a number of reasons contribute to these modest outcomes, the presence of residual symptoms is a major problem. Residual symptoms are defined as symptoms that linger despite an adequate dose and duration of an antidepressant medication. This article reviews the prevalence and clinical impact of common residual symptoms and discusses the utility of aggressively addressing residual symptoms to enhance the efficacy of antidepressant medications.

Keywords::

• antidepressant medication
• augmentation strategy
• depressive subtype
• major depressive disorder
• remission
• residual symptom

Financial & competing interests disclosure

MH Trivedi has received consulting fees from Abbott Laboratories, Inc., Abdi Brahim, Akzo (Organon Pharmaceuticals Inc.), AstraZeneca, Bristol-Myers Squibb Company, Cephalon, Inc., Fabre-Kramer Pharmaceuticals, Inc., Forest Pharmaceuticals, GlaxoSmithKline, Janssen Pharmaceutica Products, LP, Johnson & Johnson PRD, Eli Lilly & Company, Meade Johnson, Neuronetics, Otsuka Pharmaceuticals, Parke-Davis Pharmaceuticals, Inc., Pfizer, Inc., Sepracor, VantagePoint and Wyeth-Ayerst Laboratories.

MH Trivedi has received research support from the Agency for Healthcare Research and Quality, Corcept Therapeutics, Inc., Cyberonics, Inc., Merck, National Alliance for Research in Schizophrenia and Depression, National Institute of Mental Health, National Institute on Drug Abuse, Novartis, Pharmacia & Upjohn, Predix Pharmaceuticals, Solvay Pharmaceuticals, Inc. and Targacept.

BT Kurian has received grant support from Targacept, Inc., National Institute of Mental Health (NIMH) and the Agency for Healthcare Research and Quality (AHRQ). TL Greer has received grant support from the National Alliance for Research on Depression and Schizophrenia (NARSAD). The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.