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MDD Remission


Practitioners discuss the need to treat patients with major depressive disorder (MDD) to a complete remission vs a decline in symptomology.

Greg Mattingly, MD: We talk about this term that we’ve mentioned a couple of times already today, remission. I’ve never had a patient come in yet saying, “Dr Mattingly, I want to go in remission with my depression.”What’s the patient-centric way to describe that with a patient? How do you ask, “Are you where you want to be? Are you back to where you should be?”

Jeremy Schreiber, MSN, PMHNP-BC: Interestingly, a lot of times I ask my patients, “How are you feeling? Are you back to where you want to be? What are you doing for fun?” What does the patient’s baseline look like? All patients are going to have a different baseline. One of the things that I find [is] that people with depression, they oftentimes are not doing the things that they enjoy doing. Even if they want to do them, they’re still not doing them. When I talk to patients, I oftentimes ask them about their hobbies. “What is it that you like to do?” Patients will come in and they’ll say, “Oh, I used to paint”, or “I used to play my guitar,” and these sorts of things. I use that as one of my benchmarks for how my patients are doing. Are they feeling like they’re getting better? Are they actually all the way better? Are they engaged in the hobbies and the things that they used to enjoy as well? It’s not simply, “Oh, well Jeremy, I have a 4on my PHQ-9 [Patient Health Questionnaire-9], I’m all the way better, or a 2or a 0on my PHQ-9. I’m cured.”No one ever tells me that. I also want to know about their relationships, but not just with partners and significant others, but how are they doing with getting along with other people at work? Is there irritability as high as it used to be before? Did they have the motivation to get up and do the things that they want to do? Do they have goals for the future? Which I think is also big. Part of depression and part of the symptoms there is you see patients just develop almost a perception of, “Well, it’s here now and I’m worried about today.”They aren’t thinking oftentimes about the future and what the future looks like, and where do they see themselves and do they want to retire, or do they want to get married? They’re just thinking about here and now. In addition to hobbies, I also like to think about, are my patients thinking about the future and what it is that they want to do? Do they have enough goal orientation to start to chase down those things? I don’t want to say too much goal orientation because that would be a separate lecture. This is more of a lecture about unipolar today.

Greg Mattingly, MD: 100%. You said something that hit home with me. I’ve done a number of studies looking at resilience and it’s one of my hot areas of research. How do we help our patients and ourselves to be more resilient? Feeling optimistic about the future has one of the strongest links to being resilient under stress and not decompensating back into another depression. I’m optimistic about the future. I feel like my life has a positive impact on those around me. Two things that we know when somebody’s depressed [are], cognitively their brain isn’t working the way it should. Processing speed is decreased by about 40%. You’re getting about 40% less done at work, 40% less done at home. If you’re studying, you get 40% less done in the class. [A] 40% decrease in cognitive productivity when you’re depressed. The other thing we find is when somebody is only partially better, if you give them a choice between a hard task or an easy task, they choose the easy task.

Jeremy Schreiber, MSN, PMHNP-BC: I must be depressed.

Greg Mattingly, MD: If I give you an easy task with like a low payout, [let’s say] I give you a quarter for each easy task or I give you a hard task and it’s going to be harder, but you get $5. When somebody’s depressed, they choose the easy task with the easy reward. When they get better, when they feel more self-confident, they’ll take the harder task with the harder reward. I just had a university student, Jeremy, and he said, “Dr. Mattingly, I used to be the one that would stay up late to study because I wanted to be number one in my class. Now I’m OK with just sitting in my class.”That’s partially treated depression. That’s somebody who’s better, but not well. I think when you think about what’s that look like in the life of a patient, a mom, a dad, a student, how do we describe that to our patients?


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