Therapeutic goals, clinical indicators and follow up in major depressive disorder; [Major depresif bozuklukta tedavi hedefleri ve tedavinin izlenmesi]
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Date
2011
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Abstract
Major depressive disorder constitutes a very important health problem because of its associated disability. The treatment plan for depression should included targets, since the better the goals are described, the more likely the treatment will be followed up and monitored. For this purpose, clinical psychiatric scales are useful. Psychiatric rating scales are instruments to monitor depression and its treatment in a useful and operational way. Response may be the most important criterion to be monitored and is defined as a 50% reduction in the index scale score. Inadequate response to the treatment is defined as a 25-50% reduction and no response to treatment is defined as a reduction below 25%. Remission is defined as the improvement of most symptoms and during the monitoring of remission the target response is a score below the cutoff score, e.g. reduction of the Hamilton Depression Rating Scale below 7 and reduction of the Montgomery Asberg Scale below 10. While these two scales are the most used instruments in monitoring the treatment of depression, self-rated scales, while less preferred, may also be used. In the global assessment of patients, the Clinical Global Impression scale may be used. The achievement of remission in depression lowers healthcare costs significantly, reduces disease burden, improves quality of life, and reduces medical and psychiatric morbidity and mortality. Even though the functionality of patients improves,when assessed subjectively, it is not possible to suggest that it reaches premorbid levels; thus, in the follow-up of patients, functionality should be monitored, as well as response and remission.