New depression and anxiety treatment goals defined

December 03, 2001

Mental health leaders reconcile provider and consumer expectations

NEW YORK, Dec. 3, 2001 - To be successful, treatment for the more than 20 million Americans suffering from depression and anxiety must aim not for partial improvement of the illness but for remission (virtual elimination of symptoms) and complete recovery of quality of life, according to an expert panel comprised of leading U.S. mental health clinicians, researchers, consumers and advocates convened by the National Mental Health Association (NMHA) on Friday, Nov. 30th, in New York City.

"The panel's ability to find a common ground between the medical and consumer models of treatment for people with depression and anxiety is a major achievement," said Michael M. Faenza, M.S.S.W., NMHA president and CEO and moderator of the roundtable, "The Science of Remission, The Art of Recovery." "Participants agreed that the mental health community must recognize that remission is a step on the way to recovery of the whole person and that the journey includes improved evaluation of illness severity, greater acceptance of remission and recovery as the desired outcome for patients, and better consideration of patients' culture, age, gender and quality of life."

In addition to the need for mental health professionals to communicate that recovery is possible, stated the participants, consumers must take ownership of their illness and treatment, challenging their providers to explore different options if recovery is not being achieved.

NMHA held the roundtable to address the disconnect between provider and consumer expectations about treatment and outcomes. Panelists discussed research findings of medical and non-medical services and supports for both remission and recovery. NMHA will seek to publish the conference proceedings, making recommendations that the medical and consumer communities can use to improve treatment and patient quality of life.

-Discussing The Goals of Remission of Symptoms and Recovery-

Remission of symptoms is the treatment goal increasingly accepted by the medical community, explained one of three discussion leaders at the roundtable, Charles B. Nemeroff, M.D., Ph.D., Reunette W. Harris professor and chairman of the Department of Psychiatry and Behavioral Sciences at Emory University School of Medicine in Atlanta.

Remission aims for the virtual elimination of a person's symptoms of depression or anxiety and restoration of his or her psychosocial and occupational functioning - essentially allowing a return to enjoying life and making strides toward recovery, he added. A person achieves remission when symptoms are absent for at least six months. In contrast, response, or only partial improvement of symptoms, is a common standard of care.

"The consequences of failing to achieve remission of depression or anxiety symptoms are that a consumer has a greater risk of relapse and symptom recurrence," Nemeroff said. "Remission of symptoms is a critical step on the road to a person's complete recovery."

Nemeroff also shared recent research, published by Michael E. Thase, M.D., in the British Journal of Psychiatry, suggesting that certain treatments may provide higher remission rates.

Remission and recovery are usually achieved through a combination of medication, psychotherapy and peer and community support, explained the roundtable's second discussion leader, Courtenay M. Harding, Ph.D., director of the Institute for the Study of Human Resilience and professor at Boston University's Sargent College of Health and Rehabilitation Sciences.

Harding shared longitudinal research showing that psychosocial rehabilitation services, with medication, improve outcomes and promote recovery. Remission is not an end, but rather a milestone on the way to recovery, the ability to lead a life less hindered by illness.

"Hearing from a mental health professional that recovery is an achievable goal can make a tremendous difference in a person's approach to treatment and success," said Harding. "Professionals and consumers alike need to know that serious mental illness is not necessarily a life-long diagnosis -- a person can recover and enjoy a full and productive life at work and at home, with episodes of illness progressively tapering off."

To promote the recovery process, treatment must focus on the whole "person behind the disorder." Beyond determining and using appropriate medications, therapy should address a patient's sense of control, self-esteem and self-determination, including re-learning optimism, Harding said. To reclaim a life, patients should seek support from friends and family, on the job, and find ways to build self-sufficiency and contribute to their community.

Integration of medical, psychological and social services is critical to begin and then sustain recovery from mental illness, summarized the roundtable's third discussion leader Martha M. Manning, Ph.D., clinical psychologist and author of Undercurrents: A Life Beneath the Surface, an account of her own battle with depression. Developing a shared vocabulary of suffering and healing between patients, their doctors, therapists and families can help translate exciting discoveries in science to the recovery of "real-life" people with a mental illness.

Peer-to-peer education can significantly enhance the message that treatment can be successful, which helps patients with the recovery process, added Manning.

"Depression is not a trifling illness. It is very serious and despair is the nature of the beast," said Manning. "Talking to someone who lost but then regained his life can help a patient create a baseline, understand recovery and set treatment goals. The patient needs to learn that there is a cause for hope in treatment and that treatment, in fact, helps restore hope."

Manning also noted that the recovery is not a straight, upwards process, so mental health professionals and patients need to understand that remission and recovery need to reflect the fluidity of life.

In addition to Nemeroff, Harding and Manning, roundtable participants included representatives from such organizations as the American Psychiatric Association, the National Mental Health Consumers' Self-Help Clearinghouse, the National People of Color Consumer/Survivor Network, the Consumer Organization Networking and Technical Assistance Center, the National Depressive and Manic Depressive Association (NDMDA) and the New York State Office of Mental Health.

-Education and Political Action Explored-

In addition to finding common ground in treatment goals, the participants also urged that primary care physicians, family practitioners and internists must be further educated about mood disorders causes, treatments and outcomes and how to help their depression and anxiety patients understand their illnesses and the recovery process.

Additionally, participants pressed for political action to reap social changes in mental health treatment and for increased research funding to examine not just the roots of mood disorders but also patients' treatment outcomes.

-About Depression and Generalized Anxiety Disorder (GAD)-

Clinical depression is one of the most common mental illnesses, affecting more than 19 million Americans each year. Depression causes people to lose pleasure from daily life, can complicate other medical conditions and can be serious enough to lead to suicide. Fewer than half of those suffering from this illness seek treatment.

Generalized Anxiety Disorder (GAD) affects about four million Americans every year. The illness is characterized by six months or more of exaggerated worry and tension that is unfounded or much more severe than the normal anxiety most people experience. People with this disorder are unable to relax and often experience physical symptoms such as fatigue, trembling, muscle tension, headaches, irritability or hot flashes. Research shows that GAD and depression often coexist.
About the National Mental Health Association

The National Mental Health Association is the country''s oldest and largest nonprofit organization addressing all aspects of mental health and mental illness. With more than 340 affiliates nationwide, NMHA works to improve the mental health of all Americans through advocacy, education, research and service.

"The Science of Remission, The Art of Recovery" was supported by an unrestricted educational grant from Wyeth-Ayerst Laboratories.

Porter Novelli

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