Understanding Response and Remission in MDD
Dr. Alva raises the issue of patients who hear the word response and conclude they are cured. Dr. DeBattista explains how he defines partial response, remission, and relapse, and how he keeps residual insomnia and anhedonia from being mistaken for recovery. Dr. DeBattista says he does not use these terms with patients because they belong to clinical research. In trials, 25% improvement marks a partial response and 50% marks a response, but this framework does not help the person in front of him. Instead, he asks: do you feel depressed and are you able to function at the level you could before you were depressed?
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What Counselling in Two Different Countries Taught Me: Hansel Wong on Connection, Curiosity, and CultureDefining Meaningful Improvement Beyond Scales
When asked how he achieves meaningful improvement, Dr. DeBattista admits that what matters to a patient may never show up on a scale. He describes a tertiary care patient who had tried everything, including ECT and an implanted device. Only esketamine helped, and only with her suicidality, which insurers cannot see on a scale. If responses are not simply yes or no, he calls this good evidence of remission. He will not use the word remission for anything less than a full response. For that patient, he says, it is a partial response. He teaches patients that any persistent symptom means the illness is still present and can return. A single residual symptom increases the risk of relapse, the risk of suicide, and the risk of an incomplete return to baseline functioning.
Timing and Probability in Antidepressant Trials
Over time, he teaches four to eight weeks for antidepressants to reach maximal response, but notes conditional probability data showing modest odds at week eight if there is no response by weeks two to four. Our next episode, „Positioning MDD Therapy That Acts Faster and Their Monitoring Demands,”refers to the fact that patients deserve a faster-acting agent before anything is considered failed.