Vol 10, N°4 Remission in depression
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linicians working with depressed patients are often confronted with the unsatisfactory degree of remis- sion that current therapeutic strategies yield, and with the vexing problems of relapse and recurrence.1 In clinical medicine, the term “recovery” connotes the act of regain- ing or returning toward a normal or usual state of health. However, there is a lack of consensus regarding the use of this term (which may indicate both a process and a state), as well as of the related word “remission.”This lat- ter indicates a temporary abatement of the symptoms of a disease. Such ambiguities reflect on the concepts of relapse (the return of a disease after its apparent cessa- tion) and recurrence (the return of symptoms after a remission). In an attempt to overcome these flaws, Frank et al2 pro- posed a set of definitions which they referred to as lon- gitudinal studies of mood disorders, but may entail more general applicability in psychiatry. Remission (which is differentiated into partial and full remission) is a rela- tively brief period during which an improvement of suf- ficient magnitude is observed and the individual no longer meets syndromal criteria for the disorder. Recovery implies a more sustained remission, and raises the possibility that treatment can be discontinued or prolonged with the aim of prevention. Relapse is a return of symptoms satisfying the full syndromal crite- ria during the period of remission, whereas recurrence C l i n i c a l  r e s e a r c h C Copyright © 2008 LLS SAS. All rights reserved www.dialogues-cns.org Psychosocial determinants of recovery in depression Giovanni A. Fava, MD; Dalila Visani, PsyD Keywords: depression; recovery; staging; sequential model; psychological well- being Author affiliations:  Department of Psychology, University of Bologna, Italy (Giovanni A. Fava, Dalila Visani); Department of Psychiatry, State University of New York at Buffalo, Buffalo, NY (Giovanni A. Fava) Address for correspondence:  Prof Giovanni A. Fava, Department of Psychology, University of Bologna, Viale Berti Pichat 5, 40127 Bologna, Italy (e-mail: giovanniandrea.fava@unibo.it) There is a growing body of literature on residual symp- toms after apparently successful treatment. The strong prognostic value of subthreshold symptomatology upon remission and the relationship between residual and pro- dromal symptomatology (the rollback phenomenon) have been outlined. Most residual symptoms also occur in the prodromal phase of depression and may progress to become prodromes of relapse. These findings entail important implications. It is necessary to closely monitor the patient throughout the different phases of illness and to assess the quality and extent of residual symptoms. A more stringent definition of recovery, which is not limited to symptomatic assessment, but includes psychological well-being, seems to be necessary. New therapeutic strate- gies for improving the level of remission, such as treat- ment of residual symptoms that progress to become pro- dromes of relapse and/or increasing psychological well-being, appear to yield more lasting benefits. The sequential model may provide room for innovative treat- ment approaches, including the use of drugs for specifi- cally addressing residual symptoms. As occurs in other medical disorders (such as diabetes and hypertension), the active role of the patient in achieving recovery (self-ther- apy homework) should be pursued. © 2008, LLS SAS Dialogues Clin Neurosci. 2008;10:461-472.