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Dr Kelsey is medical director of the Georgia Institute of Mood and Anxiety Disorders in Atlanta.

Correspondence to Jeffrey E. Kelsey, MD, PhD, Medical Director, Georgia Institute of Mood and Anxiety Disorders, 7 Piedmont Center, Suite 300, 3525 Piedmont Rd, Atlanta, GA 30305-1537. E-mail: jekelsey{at}bellsouth.net

Major Depressive Disorder (MDD) is a common clinical condition encountered in primary care practices. Left untreated or, more commonly, undertreated, MDD typically results in significant distress and dysfunction. Successful treatment of MDD, usually defined as achieving sustained remission, is an attainable goal. As such, sustained remission should be the goal sought by physicians and patients. A number of variables have an impact on the likelihood of achieving and sustaining remission including the length of the depressive episode, the completeness of the response to treatment, and whether remission is achieved relatively early in treatment. The selection of pharmacotherapeutic agents and the relative probability of achieving remission has only recently been investigated in outpatient populations, though this issue has been explored in inpatient studies for more than a decade.

This article reviews these variables and presents strategies with the goal of achieving remission for patients with MDD. The importance of both pharmacotherapy, where indicated, as well as psychotherapy is discussed. Finally, remission is presented as a necessary first step to ensure an optimal long-term outcome, rather than as the final goal of treatment.