Report by the ACNP Task Force on Response and Remission in Major Depressive Disorder

Abstract

This report summarizes recommendations from the ACNP Task Force on the conceptualization of remission and its implications for defining recovery, relapse, recurrence, and response for clinical investigators and practicing clinicians. Given the strong implications of remission for better function and a better prognosis, remission is a valid, clinically relevant end point for both practitioners and investigators. Not all depressed patients, however, will reach remission. Response is a less desirable primary outcome in trials because it depends highly on the initial (often single) baseline measure of symptom severity. It is recommended that remission be ascribed after 3 consecutive weeks during which minimal symptom status (absence of both sadness and reduced interest/pleasure along with the presence of fewer than three of the remaining seven DSM-IV-TR diagnostic criterion symptoms) is maintained. Once achieved, remission can only be lost if followed by a relapse. Recovery is ascribed after at least 4 months following the onset of remission, during which a relapse has not occurred. Recovery, once achieved, can only be lost if followed by a recurrence. Day-to-day functioning and quality of life are important secondary end points, but they were not included in the proposed definitions of response, remission, recovery, relapse, or recurrence. These recommendations suggest that symptom ratings that measure all nine criterion symptom domains to define a major depressive episode are preferred as they provide a more certain ascertainment of remission. These recommendations were based largely on logic, the need for internal consistency, and clinical experience owing to the lack of empirical evidence to test these concepts. Research to evaluate these recommendations empirically is needed.

Association of the COMT val158met Variant with Antidepressant Treatment Response in Major Depression

“…This is in accordance with the recently published ACNP task force guidelines on response and remission in major depressive disorder, which recommend monitoring of changes within a subject (for whom initial severity is fixed) rather than comparing response rates between subjects for whom initial values range widely (Rush et al, 2006). The intra-individual weekly change score introduced here considered the weekly changes in HAM-D scores after week 1 up to week 6.…”

“…In the present study, the influence of the COMT val158met polymorphism on clinical response to antidepressants was investigated in samples of Caucasian patients with major depression and bipolar disorder, major depressive episode, by means of a novel approach analyzing the intra-individual rather than the averaged course of therapy response, in an attempt to follow the recently published American College of Neuropsychopharmacology (ACNP) task force guidelines on response and remission in major depressive disorder (Rush et al, 2006) and therefore to possibly further clarify the role of COMT gene variation in antidepressant treatment response. Since biochemical and pharmacological studies provide support for decreased availability of dopamine and norepinephrine as a detrimental factor in the pathomechanism of depression as well as response to pharmacological antidepressive treatment, higher COMT activity, as conferred by the COMT 158val allele leading to decreased dopamine and norepinephrine availability, was hypothesized to have a negative effect on antidepressant drug response in depression.…”

Personalized medicine in major depressive disorder — Opportunities and pitfalls

“…Worldwide, MDD causes significant economic ($83 billion in the US alone) and psychosocial burdens due to the cost of hospitalization, lost work productivity and suicide. MDD is a lifelong disorder; it may be chronic or characterized by frequent recurrences with a mean of about 6 episodes in 15years [6]. Up to 40% of sufferers remain untreated and suicide is a common consequence; about half of suicide victims visited a PCP within the month prior to their death [2,3,7].…”

“…The ACNP Task Force report discusses MDD in the context of response, remission, recovery, relapse and recurrence [6]. Thus, despite seemingly insurmountable roadblocks, strategies are available to help the PCP to better individualize treatment and to quickly provide effective pharmacotherapy [1].…”

Definition, Assessment, and Staging of Treatment—Resistant Refractory Major Depression: A Review of Current Concepts and Methods

“…18,28 The recently completed National Institute of Mental Health-sponsored study, Sequenced Treatment Alternatives to Relieve Depression, used this criterion to define antidepressant treatment success. 29 Given the protracted and disabling nature of some cases of TRD, one may argue that even a 30% to 40% reduction in baseline symptom severity would probably provide a clinically meaningful benefit.…”