What Brings Patients In: Functional Symptoms and Remission as the Goal

Erin Crown, MHS, PA-C, CAQ-Psychiatry explains that the symptoms driving most patients with major depressive disorder into her clinic are the ones causing clear functional impairment. Low mood and sadness are the most visible presentation and represent one of two core diagnostic criteria for MDD. The second core criterion, anhedonia, is recognized far less often, especially early in treatment, when patients are most severely ill and focused on basic functioning. Erin Crown points to avolition, anergia, sleep disturbance, and concentration difficulty as the symptoms most likely to interfere with work and caregiving, which is why patients name them first. Symptoms such as anhedonia and appetite change, she says, often surface only once a clinician probes directly, or once a patient begins responding to treatment and can compare their current state to how they felt before the illness took hold.

Turning to treatment goals, Erin Crown states that remission is always her target, even though she does not reach it in every case. She frames unresolved symptoms as genuinely risky: they shorten time to relapse, continue to impair patients psychosocially and functionally, and raise the risk of suicide, heart attack, and stroke. Erin Crown observes that patients, particularly those experiencing anhedonia, may not believe remission is achievable, so their own treatment goals often center on whichever symptoms feel most bothersome, which can surprise a clinician hearing it for the first time. Because she does not live with a patient's symptoms, responsibilities, or daily life, Erin Crown describes her clinical role as listening carefully, asking direct questions, and respecting whatever priorities the patient sets for their own wellness journey. She works to support those individual priorities while still steering the overall treatment plan toward full symptom resolution whenever that is possible for the patient in front of her.

Up next, in "Personalizing MDD Treatment: Evidence, Experience, and Patient Values," Dr. Citrome and Dr. Harding examine what it actually takes to individualize a treatment plan once a diagnosis is in hand.