Video

Practical Updates in Primary Care Recap—Road to Recovery in Major Depressive Disorder: From Partial Response to Remission and Beyond

Rakesh Jain, MD, MPH, RD

Key Highlights

  • Many patients with major depressive disorder experience partial response to treatment, but clinicians should aim for full remission rather than accepting incomplete improvement.
  • Accurate identification of partial response and screening for comorbid conditions, such as substance use disorder or bipolar disorder, are essential to optimizing treatment outcomes.
  • Both pharmacologic and nonpharmacologic treatment strategies should be considered to address the full spectrum of patient symptoms, including anxiety, sleep disturbances, and impaired motivation.
  • Treatment selection should prioritize a balance between efficacy and tolerability, with careful attention to effect size and the risk of adverse effects such as weight gain, metabolic dysfunction, and sedation.

In this recap of the Practical Updates in Primary Care session, “Road to Recovery in Major Depressive Disorder: From Partial Response to Remission and Beyond,” Rakesh Jain, MD, MPH, highlights a persistent challenge in clinical practice: patients who improve but do not fully recover. Dr. Jain emphasizes that partial response is not an adequate endpoint and underscores the need for a more deliberate, individualized approach to treatment. The session will review the epidemiology and burden of depression, strategies to identify and address incomplete response, and practical considerations for selecting therapies that balance efficacy with tolerability.

Additional Resource: https://www.hmpglobalevents.com/pupc 

Transcript

Rakesh Jain, MD, MPH: Hello, dear colleagues. My name is Rakesh Jan. I'm a psychiatrist, and I am a clinical professor of psychiatry at Texas Tech University School of Medicine in Permian Basin. I'm here to offer you a quick recap on a presentation I'll be conducting with Wendy Wright DNP, FNP-C, FAANP, FAAN. The title is quite intriguing: Road to Recovery in Major Depressive Disorder: From Partial Response to Remission and Beyond. I hope that topic really grabs your attention because it does mine in a big way.

So, as you well know, depression is on the rise in a pretty significant way, and this presentation of ours will cover the major themes of the epidemiology, the impact of the disorder, and what can we do to help these poor, unfortunate millions of Americans who suffer from this condition. Is this a relevant topic today? You better believe it is, right? Look at your practice. Look at my practice. A very large number of people not only suffer from depression—they, in fact, suffer from depression that is stuck. That is stuck in low response or partial response status.

There are going to be very many key takeaways from this session Dr. Wright and I will offer you. One of them will include a better appreciation of how to identify partial response. Just treating people isn't enough—we must drive the depression into remission.

The second thing that's of great importance that we shall be covering is to make sure that we're not missing an important comorbidity like substance misuse disorder or bipolar disorder. We will also be talking about what are some of the nonpharmacologic treatment options, along with pharmacologic treatment options, we could offer our patients.

But then finally, we plan to address the plight of these patients in terms of side effects—what treatment to choose to minimize the risk of side effects and maximize the opportunities for improvement.

There are very many gaps in our knowledge on this topic. There really are. That's why Dr. Wright and I thought that we really ought to be presenting on this important topic—really important topic that, as I highlighted for you, is the road to recovery. There are bumps and there are curves and there are hills and there are valleys to this road to recovery in major depression. And partial response, while better than from where a person perhaps came to see us, is simply not where we want to leave them stuck.

Now, the FDA has approved several medications for us clinicians to offer our patients. We should be wise about which ones to choose—not to just offer one that we are comfortable with or the one that jumps into our mind first—but really to consider the balance between efficacy and tolerability.

When it comes to efficacy, the conversation is really moving into effect size. What is the effect size of a particular intervention? What is the magnitude of change? How reliable is the change? What are the other benefits I can expect in terms of the patient's improvement? Can I improve their anxiety, their sleep, their motivation, their drive? Whatever the challenges for that individual patient might be, they all have to be addressed.

And needless to say, we need to address them with hopefully no side effects—though that's more a hope than reality, right? But in particular: weight gain, metabolic dysfunction, prolactin elevation, sedation, apathy induction—those are all things to be kept in mind. And our goal in this presentation is to offer you a fair, balanced, high-quality presentation that isn't just intellectually rigorous, which it will be, but also highly practical. It has to be something that is actionable immediately by all clinicians.

So, thank you very much for letting me talk with you about our presentation, The Road to Recovery in Major Depression: From Partial Response To Full Remission. It is a worthy goal, my dear friends, and we look forward to seeing you during the presentation. Goodbye for now.

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