Distinguishing functional from syndromal recovery: implications for clinical care and research.

Abstract

J Clin Psychiatry 2015;76(6):e832–e834 (doi:10.4088/JCP.15com09859). © Copyright 2015 Physicians Postgraduate Press, Inc. T report by van der Voort and colleagues1 provides persuasive evidence that both major depressive and bipolar disorders are associated with substantial functional impairment not only during but also following the end of syndromal episodes. Some reports2 have suggested that most depressed patients have full functional recovery once they achieve symptomatic remission; others3 are less certain. The present report is based on a sample of patients larger and far more representative than samples of subjects selected for clinical trials. This more definitive and generalizable study clearly shows that syndrome resolution is associated with improvement in but not full normalization of function. In short, functional recovery is neither rapid nor complete even a year after patients no longer meet criteria for being in the syndromal state. This study also found that longer episode durations and more mood episodes were each associated with both worse and slower functional recovery. This finding is consistent with the notion that these mood episodes create environmental or life circumstances, or brain function changes, from which functional recovery takes time. For example, disrupted work or marital relationships may require much effort, time, and realignment of expectations before these critical relationships are back on track and again running smoothly. This finding also makes the case for earlier intervention in order to avoid an accumulation of ever more tragic circumstances or central nervous system effects created by prolonged and recurrent illness episodes. A third critical finding was that depressive symptoms were found to be a major contributor to prolonged poor function and delayed functional recovery, even after recovery from the syndrome. This important finding highlights that the aim of treatment must be full and complete symptom resolution (symptom remission) rather than response or removal of most of the symptoms, not only to reduce the risk of relapse4 but also to enhance recovery. This finding also aligns with other studies that have shown remission to be associated with a far better prognosis than is response without remission.5,6