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Do we always need to treat major depression for many months?

Does major depressive disorder always need long-term treatment? This was a key question addressed by speakers looking at the course of major depression, and at post-partum depression.

Eduard Vieta, Spain, presented information on both the episodic and chronic aspects of major depressive disorder (MDD), and how changes in treatment strategies might reduce its chronicity in some patients.

The diagnosis of MDD using DSM-5 criteria is based on a relatively short episode characterized by changes in affect, cognition and functioning Patients may receive a diagnosis of MDD as the result of a single episode, however many patients have recurrent episodes of varying lengths, separated by periods of remission. In addition, patients with chronic disease commonly experience residual symptoms during periods of remission, and these carry a disease morbidity and a greater risk of relapse1,2.

When does MDD become chronic?

Aim to treat rapidly and effectively, achieving full remission with no residual symptoms

Patients who respond quickly to treatment and experience remission within 6 weeks of treatment onset are more likely to remain free of residual symptoms in the long term3. This is therefore an important consideration when treating patients. Clinicians should aim to treat rapidly and effectively, and achieve full remission with no residual symptoms to avoid disease recurrence.

The history of development of new antidepressants has undoubtedly brought many improvements for patients. For many years the focus has been on monoaminergic mechanisms of action, but these therapies may not prove sufficient to manage all symptoms in some patients, and these drugs can take several weeks to reach their maximum therapeutic effect. This presents challenges to patients and clinicians in the rapid management of new, emerging symptoms. Development of novel antidepressants with a short time to maximal effect may allow such rapid treatment of new episodes of depression, and has the potential to improve the chronicity of MDD for some patients.

Postpartum depression often goes undiagnosed

A large proportion of women with PPD go unrecognised and undiagnosed

One episodic form of MDD is Postpartum Depression (PPD), which was discussed by Siegfried Kasper, Austria. This is obviously MDD that is temporally defined as during pregnancy or up to one year after childbirth. Specific risk factors for PPD include pregnancy-associated factors, such as hormonal fluctuations4 and perinatal stressors5 including difficulty breastfeeding and/or bonding with the infant, social isolation, and anxiety. Currently, a large proportion of women with PPD go unrecognized and undiagnosed, and of those who are diagnosed, many are untreated. There is no consensus on the effectiveness of currently available treatment options in Europe, and any treatment needs to address safety of the infant during pregnancy or lactation5.

Timely diagnosis and effective treatment of depression in its early stages has the potential to reduce its chronicity, and therefore the burden of disease in patients.

Our correspondent’s highlights from the symposium are meant as a fair representation of the scientific content presented. The views and opinions expressed on this page do not necessarily reflect those of Lundbeck.

References
  1. Vieta E et al J Affect Disord 2008;107:169
  2. Mascha C et al. J Clin Psychiat 2010;71:984–91.
  3. Nierenberg AA et al. Psychol Med 2010;40:41–50.
  4. Schiller CE et al. CNS Spectr 2015;20:48-59
  5. Menard C Neurosci 2016;321:138–62
  6. Berle JO et al. Curr Womens Health Rev 2011;7:28–34
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