Psychological Medicine



Editorial Review

The concept of recovery in major depression


GIOVANNI A. FAVA a1a2c1, CHIARA RUINI a1 and CARLOTTA BELAISE a1
a1 Affective Disorders Program, Department of Psychology, University of Bologna, Italy
a2 Department of Psychiatry, State University of New York at Buffalo, NY, USA

Article author query
fava ga   [PubMed][Google Scholar] 
ruini c   [PubMed][Google Scholar] 
belaise c   [PubMed][Google Scholar] 

Abstract

Background. There is increasing literature on the unsatisfactory degree of remission that current therapeutic strategies yield in unipolar depression. The aims of this review were to survey the available literature on residual symptoms of depression, to introduce new targets for therapy and to outline a more stringent definition of recovery.

Method. Studies were identified by using MEDLINE (English language articles published from 1967 to June 2006; keywords: recovery, remission, residual symptoms, sequential treatment, drugs and psychotherapy, related to depressive disorder and depression) and a manual search of the literature and Index Medicus for the years 1960–2006.

Results. Most patients report residual symptoms despite apparently successful treatment. Residual symptoms upon remission have a strong prognostic value. There appears to be a relationship between residual and prodromal symptomatology. The concept of recovery should involve psychological well-being.

Conclusions. Appraisal of subclinical symptomatology in depression has important implications for pathophysiological models of disease and relapse prevention. New therapeutic strategies for improving the level of remission, such as treatment on residual symptoms that progress to become prodromes of relapse, may yield more lasting benefits.

(Published Online October 23 2006)


Correspondence:
c1 Department of Psychology, viale Berti Pichat 5, 40127 Bologna, Italy. (Email: giovanniandrea.fava@unibo.it)


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