Raising the Bar in MDD: What True Remission Looks Like

This episode, "Raising the Bar in MDD: What True Remission Looks Like," features Erin Crown, MHS, PA-C, CAQ-Psychiatry drawing a sharp clinical line between partial improvement and true recovery.

Erin Crown distinguishes clinical response from clinical remission using the standardized measures common in trials. The Montgomery-Asberg Depression Rating Scale, or MADRS, is the tool most often used to gauge antidepressant benefit in clinical trial settings. Response is typically defined as a 50 percent or greater reduction in the total MADRS score, while protocols usually define remission as a total score of 10, sometimes 12, and occasionally as low as 8. In everyday practice, Erin Crown relies more on the PHQ-9, where a patient starting around 20 should ideally reach single digits or zero to demonstrate response or remission. She compares this to diabetes management: a patient starting with a hemoglobin A1C of 12 who improves to 8 or 9 with treatment has responded, but no endocrinologist would consider that result acceptable long term. Depression deserves the same standard, she argues, even though clinicians often do not think of it that way.

Beyond the numbers, Erin Crown says what she is really assessing is a return to life as the patient knew it before depression arrived. She illustrates this with a patient who had been severely ill and isolated for over 13 years, disconnected from family and friends, living in a disordered home. He had paid for cable service for four years without using it because he could not bring himself to call and schedule a repair. After starting an effective treatment, he not only responded but remitted, telling Erin Crown he finally felt like himself again, the way he had felt before depression ever began. For Erin Crown, that statement, not a rating scale score, is what remission actually sounds like from a patient in a real clinical setting, and it is the outcome she measures herself against.

Up next, in "Beyond the Questionnaire: Tracking MDD Progress Through Everyday Conversation," Erin Crown, MHS, PA-C, CAQ-Psychiatry walks through the practical tools and conversations she uses to track progress between visits.