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The number of people in the U.S. living with significant depression has tripled over the past 20 years. On the heels of two decades of drug therapy for the treatment of depression, mental health professionals feel that much has been learned about the condition which affects around 27 million Americans. One thing seems particularly clear – Americans are looking for more than symptom treatment, they are looking for a cure. At the moment mental health providers do not have an adequate tool for assessing whether or not someone has been cured of their depression.

Chronic depression is defined by a depressive episode that lasts for two years or longer. The standard of care for treating chronic depression is two years of continuing treatment beyond the time that symptoms disappear. Patients who do not fulfill the prescribed treatment regimen are at an increased risk for relapse. Even if the person does not experience a full-blown relapse into major depression, experts warn that shortened treatment can mean less than full work or social functioning. That is because when depression strikes, several regions of the brain are affected and the brain is slow to repair and reset impacted circuitry.

Part of the problem is that so few patients adhere to the prescribed treatment standard. What often results when patients do not complete the entire treatment schedule is a sort of low-grade disorder in mood. Many patients, who begin by using anti-depressants, quit using them after just three or four months. National reports say that less than one quarter of depressed patients receive full treatment for the condition while 40 percent receive no treatment whatsoever. Patients are using medication to alleviate symptoms but are rarely reaching the point of full remission.

A second problem is that of disconnect between how a patient and his/her mental health provider define remission or cure. Studies show that while clinicians use a symptom-based measure in order to determine remission, patients are equally concerned about a return to a quality of life that is less quantifiable. Patients are looking to regain a feeling of overall well-being and a sense of enjoyment in life in addition to better coping and functioning.

In short, patients are looking not just for remission but for a cure. Patients may be responsible for discontinuing treatment too soon, but providers may need to better define a threshold for cure. Until then, the best indications of depression recovery are better interpersonal relationships, better work ability, improved physical health and an upswing in quality of life.

One mental health professional has suggested keeping track of symptoms experienced during depressive episodes so that as mood improves, the patient has an objective measure for improvement.

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