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duminică, 15 iulie 2012

Response describes a gradual improvement during depression treatment and usually implies a
treatment effect.7 Response is usually defined as a 50% improvement from baseline to end point on
depression rating scales such as the 17-item Hamilton Depression Rating Scale (HAMD-17) or the
Montgomery-Åsberg Depression Rating Scale (MADRS). Response tends to occur early on during the
course of treatment (eg, after 2 weeks8) and usually precedes remission as a precondition. It is the
main categorical outcome parameter of short-term antidepressant trials. Thus, response occurs
during the acute treatment phase of major depression.

As stated before, remission refers to a relatively short symptom- free period.7 Usually, remission is
defined by a threshold on a depression rating scale. In contrast to response, remission is not
necessarily related to any treatment. It can also occur spontaneously in patients without treatment.
Michael Thase has shown that a threshold of equal to or below 7 on the HAMD-17 best distinguished
healthy control persons from patients with major depression (Figure 2).9 Recently, this threshold was
replicated in a large sample of naturalistically treated patients with major depression.10 In contrast to
response, remission can occur with or without treatment. From a therapist’s perspective, remission is
the starting point of continuation therapy with the primary goal of sustaining remission until recovery
is achieved.
The concept of recovery implies a prolonged period of remission. This period should be long enough
so that a major depressive episode (MDE) is unlikely to occur in the near future.3 In other words, once
a patient achieves recovery, many months of remission can be anticipated.3 In accordance with
remission, recovery can be ascribed while the patient is either on or off treatment. From a theoretical
point of view, recovery implies that the illness activity of the MDE is no longer present, but it is
important to keep in mind that the underlying vulnerability may still be present. This also means that
recovery refers only to the last episode and not to the affective disorder as a whole.
Thus, recovery is only lost if recurrence occurs. The ACNP Task Force recommends a time span of 4
months, while others have repeatedly used a 6-month duration to define recovery.11 The fact that a
patient has recovered also raises the possibility for the treating clinician to consider discontinuing
treatment, which is of course one of the most important clinical implications of recovery.
Relapse and recurrence
Both terms refer to the reappearance of a full-blown MDE. The essential distinction between both
terms is the time at which each event occurs. According to the description by Frank et al, “relapse” is
“a return of symptoms satisfying full syndrome criteria for an episode that occurs during a period of
remission, but before recovery.”2 This again points to how critical the time criterion of recovery and
the symptomatic threshold of remission are, as all other definitions are based upon them. As for “recurrence,” this is defined as “the appearance of a new episode of MDE, occurring during recovery.”2
In summary, we not only discriminate remission and recovery, but also relapse as an early return or
“fall back” into the initial MDE, and recurrence as a late return of the illness and as a development of a
new depressive episode, unrelated to the prior, “cured” episode, respectively.

Alte surse:
Psihopatologia cantitativã a fixat praguri de severitate pentru definirea unui rãspuns terapeutic total (scor < 7 pe scala Hamilton - HDRS cu 17 itemi, sau scor < 8-12 pe scala MADRS, sau rãspuns nul sau insuficient, scor > 15 sau 18 pe Hamilton Depression Rating Scale, scor > 15-20 pe Montogomery Asberg Depression Rating Scale (MADRS).

Răspuns/response=Reducerea clinic semnificativă a severităţii simptomelor în comparaţie cu baseline
Remisiune/Remission=Absenţa sau aproape absenţa simptomelor şi resturarea funcţionării
Recădere (Resuta) /Relapse =Reapariţia simptomelor depresive în timpul continuării tratamentului (in perioada de remisiune/remission de 6 luni )
Recurenţă(recidiva) /Reccurance=Nou episod depresiv apărut după o remisiune susţinută a unui episod precedent (in perioada de recuperare/recovery dupa 6 luni )

În mod schematic, se pot trasa 3 faze succesive în tratamentul tulburãrilor afective:
- Faza acutã sau curativã; 1-3 luni
- Faza de continuare 6 luni
- Faza de mentinere.> 6luni

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