• George I Papakostas.
• Treatment-Resistant Depression Studies, Massachusetts General Hospital, Harvard Medical School, 15 Parkman St, WACC#812, Boston, MA 02114, USA. gpapakostas@partners.org
• Am J Manag Care. 2009 Dec 1; 15 (11 Suppl): S316S321S316-21.

AbstractPatients with major depressive disorder (MDD) can experience persistent and substantial functional impairment, and the extent of psychosocial impairment often varies with symptom severity. Factors that may contribute to restoration of psychosocial functioning include the patient's lifetime functional trajectory, the overall effectiveness of depression therapy, and the duration and quality of remission. Patients who achieve full asymptomatic remission from depressive symptoms can still experience functional impairment; thus, restoring psychosocial functioning is increasingly being identified as an important goal of depression therapy. The more effective the therapeutic approach employed to resolve symptoms of depression (eg, long-term duration of treatment, monitoring of patient adherence to treatment, maintenance of asymptomatic remission), the more likely it is that patients with MDD will experience a full restoration of premorbid psychosocial functioning. The goals of this article are to discuss the potential origins of psychosocial impairment, provide literature-based evidence that achieving asymptomatic remission (ie, remission without residual symptoms) is crucial so that functional improvement continues beyond acute-phase treatment, and emphasize the need for an expanded assessment of the illness that fundamentally includes an evaluation of psychosocial functioning, since the restoration of psychosocial functioning does not always accompany the resolution of symptoms in MDD.

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