The importance of a full symptomatic assessment

It is well known and understood that no two patients experience depression in the same way; that depression manifests in many different symptoms which affect people to varying degrees.1-4

So correctly identifying depression is one challenge; but, with the diagnosis made, how important is it to assess a patient’s symptoms individually?

Despite the fact that the symptoms of depression are undoubtedly interconnected, research shows that resolution of mood symptoms, largely thought of as being the defining characteristic of MDD, does not necessarily predict resolution of other symptoms.3,5 In fact, cognitive symptoms such as trouble concentrating have been shown to persist beyond the point where a patient’s mood symptoms have responded to treatment. Research has shown that as many as 46% of patients continue to experience these symptoms during periods of “remission”.5

Correctly identifying depression is one challenge; but how important is it to assess a patient’s symptoms individually?

This is particularly significant given the impact of cognitive symptoms on a person’s ability to function in their daily life.6,7 From performing at work to maintaining relationships, reduced functioning arising from unresolved symptoms can have a significant impact on patients’ capacity to actively participate in, and enjoy their lives.8,9

Residual symptoms that persist beyond treatment of mood symptoms are also strong predictors of relapse in these patients, with studies showing that residual cognitive or mood symptoms independently increase the risk of relapse after six months, compared to those who did not exhibit any symptoms.10

If these symptoms are not addressed, we compromise patients’ chances of achieving functional recovery, in addition to putting them at higher risk of relapse.6,7,10 A full symptomatic assessment including individual mood, physical, and cognitive symptoms, is essential in order to set life-relevant treatment goals11,12 and give patients the best possible chance of full recovery from their depression.

References
  1. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders - Fifth Edition (DSM-5). 2013.
  2. Marazziti D et al. Eur J Pharmacol. 2010; 626(1): 83-86.
  3. Hammar A, Ardal G. Front Hum Neurosci. 2009; 3: 26.
  4. Fehnel SE et al. CNS Spectr. 2013; 25: 1-10.  
  5. Minor KL et al. J Psychiatric Res 2005; 39(4): 145-420.
  6. Habert Jet al. Prim Care Companion CNS Disord 2016; 18(5): doi:10.4088/PCC.15r01926.
  7. Jaeger J et al. Psych Res 2006; 145: 39-48.
  8. Greer TL et al. CNS Drugs. 2010; 24(4): 267-284.
  9. Withall A et al. Psychol Med. 2009; 39(3): 393-402.
  10. Saragoussi D et al. Poster presented at the American Psychiatric Association 169th Annual Meeting. May 14-18. 2016.
  11. McIntyre RS et al. Depress Anxiety. 2013; 30(6): 515-527.
  12. Rosenzweig-Lipson S et al. Pharmacol Ther. 2007; 113(1): 134-153.
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