Remission in Depression

Table 1.

Study Comparisons	Remission Rates	Odds Ratio (95% Confidence Interval)
Venlafaxine vs all SSRIs	41% vs 35%	1.309 (1.181-1.451)
Venlafaxine vs fluoxetine	42% vs 34%	1.413 (1.221–1.635)
Venlafaxine vs paroxetine	44% vs 39%	1.203 (0.970-1.492)
Venlafaxine vs other SSRIs	37% vs 32%	1.164 (0.925–1.464)
Placebo	24%

Table 1. Remission Rates with Venlafaxine and SSRIs^[13]

Montgomery SA, Henry J, McDonald G, et al. Selective serotonin reuptake inhibitors: meta-analysis of discontinuation rates. Int Clin Psychopharmacol. 1994;9:47-53. Abstract
Deakin B, Dursun S. Optimizing antidepressant treatment: efficacy and tolerability. Int Clin Psychopharmacol. 2002;17(suppl 1):S13-S24. Abstract
Ferrier IN. Treatment of major depression: is improvement enough? J Clin Psychiatry. 1999;60(suppl 6):10-14.
Kelsey JE. Clinician perspective on achieving and maintaining remission in depression. J Clin Psychiatry. 2001;62(suppl 26):16-21. Abstract
Thase ME. The clinical, psychosocial, and pharmacoeconomic ramifications of remission. Am J Manag Care. 2001;7(11 suppl):S377-S385.
Thase ME, Ninan PT. New goals in the treatment of depression: moving toward recovery. Psychopharmacol Bull. 2002;36(suppl 2):24-35. Abstract
Nierenberg AA, Wright EC. Evolution of remission as the new standard in the treatment of depression. J Clin Psychiatry. 1999;60(suppl 22):7-11. Abstract
Hirschfeld RM. The use of mirtazapine in difficult-to-treat patient populations. Hum Psychopharmacol. 2002;17(suppl 1):S33-S36. Abstract
Anderson IM. SSRIS versus tricyclic antidepressants in depressed inpatients: a meta-analysis of efficacy and tolerability. Depress Anxiety. 1998;7(suppl 1):11-17. Abstract
Thase ME, Entsuah AR, Rudolph RL. Remission rates during treatment with venlafaxine or selective serotonin reuptake inhibitors. Br J Psychiatry. 2001;178:234-2341. Abstract
Entsuah R, Gao B. Global benefit-risk evaluation of antidepressant action: comparison of pooled data for venlafaxine, SSRIs, and placebo. CNS Spectr. 2002;7:882-888. Abstract
Entsuah AR, Huang H, Thase ME. Response and remission rates in different subpopulations with major depressive disorder administered venlafaxine, selective serotonin reuptake inhibitors, or placebo. J Clin Psychiatry. 2001;62:869-877. Abstract
Nemeroff CB, Entsuah AR, Willard LB, Demitrack MA, Thase ME. Venlafaxine and SSRIs: pooled remission analysis. New Research Abstract NR263 from the American Psychiatric Association Meeting; May 2003; San Francisco, California.
Davidson JR, Meoni P, Haudiquet V, Cantillon M, Hackett D. Achieving remission with venlafaxine and fluoxetine in major depression: its relationship to anxiety symptoms. Depress Anxiety. 2002;16:4-13. Abstract
Tzanakaki M, Guazzelli M, Nimatoudis I, Zissis NP, Smeraldi E, Rizzo F. Increased remission rates with venlafaxine compared with fluoxetine in hospitalized patients with major depression and melancholia. Int Clin Psychopharmacol. 2000;15:29-34. Abstract
Kaplan EM. Efficacy of venlafaxine in patients with major depressive disorder who have unsustained or no response to selective serotonin reuptake inhibitors: an open-label, uncontrolled study. Clin Ther. 2002;24:1194-1200. Abstract
Poirier MF, Boyer P. Venlafaxine and paroxetine in treatment-resistant depression: double-blind, randomised comparison. Br J Psychiatry. 1999;175:12-16. Abstract
De Nayer A, Geerts S, Ruelens L, et al. Venlafaxine compared with fluoxetine in outpatients with depression and concomitant anxiety. Int J Neuropsychopharmacol. 2002;5:115-120. Abstract
Dunner DL, Goldstein DJ, Mallinckrodt C, Lu Y, Detke MJ. Duloxetine in treatment of anxiety symptoms associated with depression. Depress Anxiety. 2003;18:53-61. Abstract
Stewart DE. Physical symptoms of depression: unmet needs in special populations. J Clin Psychiatry. 2003;64(suppl 7):12-16. Abstract
Sindrup SH, Bach FW, Madsen C, Gram LF, Jensen TS. Venlafaxine versus imipramine in painful polyneuropathy: a randomized, controlled trial. Neurology. 2003;60:1284-1289. Abstract
Martin-Araguz A, Bustamante-Martinez C, de Pedro-Pijoan JM. Treatment of chronic tension type headache with mirtazapine and amitriptyline [in Spanish]. Rev Neurol. 2003;37:101-105. Abstract

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Introduction

The first selective serotonin reuptake inhibitor (SSRI) to be introduced (fluoxetine) was a significant advance in the treatment of depressive disorders. Fluoxetine was simple to administer and had a favorable side effect profile compared with the then available tricyclic antidepressants (TCAs)^[1] and monoamine oxidase inhibitors. The SSRIs that were subsequently introduced had similar clinical profiles, and these agents quickly became the treatment of choice in the treatment of depression and anxiety disorders.

Response Vs Remission

Despite the widespread use of the SSRIs, it has become increasingly evident that these agents are often less effective in treating depression compared with some dual-acting agents that affect serotonergic and noradrenergic systems.^[2] Early studies that reported similar efficacy rates of all the antidepressant classes tended to use response rather than remission rates as the criterion for improvement. Response is generally defined as a 50% decrease in scores on depression scales, such as the Hamilton Depression Rating Scale (HAMD) or the Montgomery Asberg Depression Rating Scale. Yet significant depressive symptoms are often present after a 50% improvement rate is attained. The patient may therefore have symptomatically improved but still not feel well by the response criterion.

Alternatively, remission is an indicator of wellness. When remission is achieved, the patient experiences few, if any, symptoms of depression. An HAMD score of less than 7 is often used as an indicator of remission, and this more rigorous standard is increasingly being used to judge to effectiveness of a psychopharmacological intervention.^[3-6] In addition to the greater functional and symptomatic improvement experienced in the patient who has undergone remission, there is less likelihood of relapse after remission is achieved.^[5,7]