Depression remission should be based on more than symptom status

A significant number of psychiatric patients who met symptom-based definitions of remission did not consider themselves to be in remission, according to research presented at the 2012 New Clinical Drug Evaluation Unit Annual Meeting in Phoenix.

Mark Zimmerman

“Remission should not be defined based on symptoms only,” study researcher Mark Zimmerman, MD, told Healio.com.

From March 2009 to July 2010, Zimmerman and colleagues from Brown University interviewed 274 psychiatric outpatients aged 19 to 80 years who were diagnosed with major depressive disorder based on criteria from the DSM-IV. All participants were in ongoing treatment.

The researchers rated the patients on the 17-item Hamilton Depression Rating Scale (HDRS) and the DSM-IV Global Assessment of Functioning Scale. Participants completed seven self-report scales, including the Remission from Depression Questionnaire, which assesses multiple aspects of remission, such as symptom levels, coping ability and positive mental health. Among participants who scored 7 or below on the HDRS, those who did and did not consider themselves to be in remission were compared.

Results showed that approximately half of the sample scoring 7 or below on the HDRS did not consider themselves to be in remission. According to the researchers, those who were self-described remitters had significantly lower levels of depression and anxiety than participants who did not consider themselves to be in remission (P,.001). Remitters reported significantly better quality of life (P,.001) and less functional impairment as a result of depression (P,.001) vs. those who did not consider themselves to be in remission. Remitters were also significantly less likely to report dissatisfaction in their mental health (P,.01), had higher positive mental health scores (P,.001) and reported better coping ability (P,.001).

The researchers said they disagreed with recommendations to modify treatment if a patient has not attained remission, and they also rejected the corollary that the present course of treatment should be continued if the remission threshold, based exclusively on symptom status, has been reached.

“We consider remission to be a broader construct than symptom level alone, a construct that includes other indicators of clinical status such as functioning, quality of life, resiliency in coping with stress, and a general sense of well-being,” they wrote.

Zimmerman M. Why do some depressed outpatients who are in remission according to the Hamilton Depression Rating Scale not consider themselves to be in remission? Presented at: the 2012 New Clinical Drug Evaluation Unit Annual Meeting; May 29-June 1, 2012; Phoenix.

Disclosure: Dr. Zimmerman reports no relevant financial disclosures.