Treating major depressive disorder to remission. Looking for a complete remission

La depressione unipolare e il suo trattamento. Alla ricerca di una remissione completa

A. Fagiolini, L. Bossini

Department of Mental Health, University of Siena, AOUS, USL7, Siena


This paper reports the epidemiological and clinical characteristics of depression and evaluates the differences among the various available treatments, pointing to the need to achieve a complete remission.


We reviewed the literature about epidemiology, impact and treatment of depression, as well as about the prevention of residual symptoms.


Conventional meta-analyses have shown inconsistent results in terms of efficacy and tolerability differences among antidepressants and this makes it difficult to inform treatment choice. Nonetheless it seems clear that the likelihood to respond to a given medication is influenced by the specific symptoms that each patient presents with. For instance, antidepressants that enhance noradrenergic and dopaminergic activity may afford a therapeutic advantage over serotonergic antidepressants in the treatment of symptoms associated with a reduction in positive affect, such as loss of pleasure, loss of interest, fatigue and loss of energy.


There are not univocal criteria to inform the clinician on which specific treatment should be prescribed to a specific patient and clinical remission. There are, however, preliminary indications that may help with our treatment choice, based on the close observation of all the symptoms contributing to the heterogeneous depressive picture that each patient presents with, with the ultimate goal to achieve a complete remission

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