Vol 10, N°4 Remission in depression
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ear Colleagues, The concept of depression as a syndrome is founded essentially on depressed mood; the accom- panying symptomatology (hypersomnias or insomnias, bulimia or anorexia, persecution complexes, self-deprecation, loss of the capacity to anticipate and to project oneself into the future, etc) is a result of the nature and form of the illness, as well as of the psychological profile of the individual. The precipitating factors—the patient's age, menopausal status, comorbidities, etc—also need to be taken into account. The notion of cure can be applied to the illness as a whole, or to a particular episode of this ill- ness. The idea of cure assumes a total reintegration of the premorbid psychological status of the patient. If the illness as a whole is cured, this implies that pathologic episodes will not recur, and that the depression itself has an episodic and circumstantial nature (bereavement, post-traumatic depres- sion). If, on the other hand, we speak of the cure of an episode of the illness, this implies that there may be recurrences, and in this case we refer to "remission" without excluding the possibility of a recurrent episode. Here, two of the major questions regarding the treatment of depression are raised: is the improvement of the symptomatology a manifestation of a cure or of a remission? What are the risk factors determining the possibility of recurrence? While examining these principal questions, we also need to look at which therapeutic strategies increase the chances of complete remission, which mech- anisms are involved in incomplete remission, the influence of the quality of remission on the risk of recurrence, the effect of the patient's personality on the quality of remission obtained, correlation with existing comorbidities, and the predictors of remission. These questions have all generated much interest from specialists for many years; some answers and explanations have been provided by complementary investigations: pharmacogenetics, sleep stud- ies, etc. Finally, new therapeutic approaches are providing hope for improvement in prognosis in many cases. In particular, clinicians now have recourse to treatments based on new concepts, which depart from the traditional monoaminergic theories of depression. In this issue of Dialogues in Clinical Neuroscience, we have endeavored to address all of these questions, and to this end we have called on some remarkable authors, all of whom I would like to thank, as well as Prof Dieter Naber, who agreed to coordinate this issue. Sincerely yours, Jean-Paul Macher, MD E d i t o r i a l D