Therapeutic factors in depression: new strategies

The issues of recovery and remission are getting increasing attention in depression research, particularly after the publication of the STAR*D results. The paper analyzes some issues which may hinder effective treatment of major depressive disorders: the inadequacies of a cross-sectional DSM assessment without clinical differentiation of the extent, development and seriousness of the disturbances (staging); over-emphasis on and prolongation of drug treatment, without paying attention to problems related to tolerance; neglect of the active role of the patient in achieving recovery, with the integration of psychotherapeutic strategies in a sequential model. If we are able to remove the conceptual obstacles which obstruct our view of depression and are able to correctly identify the therapeutic factors underlying treatment response we may then become aware of a different scenario in mood disorders and be able to develop therapeutic strategies of enduring quality.