Realistic expectations and a disease management model for depressed patients with persistent symptoms

Objective: To describe the efficacy of currently available treatments for depression in achieving remission and to highlight additional strategies for those patients who continue to experience persistent depressive symptoms in spite of optimal treatment. Data Sources: The authors reviewed the literature (electronic and hand searches) on the efficacy of current pharmacologic and psychotherapeutic antidepressant treatments and the utility of a chronic disease management model. A search of PubMed was conducted for English-language articles published from 1980 to 2005 using the keywords depression treatments, outcome, course of illness, and treatment resistant depression. Data Synthesis: Current treatments for depression leave a significant minority (20%-40%) of patients with persistent depressive symptoms. A disease management model that may be useful for major depressive disorder is described. Conclusions: The goal of treating depression to achieve remission, although ideal, is currently unattainable for many patients. The long-term care of patients with persisting depressive symptoms may be well served by adding a disease management component to the overall treatment strategy. Doing so may help to improve coping, interpersonal functioning, and quality of life.