LAUSR

In the past decades, hundreds of randomized trials have shown that pharmacotherapies, psychotherapies, and several other therapies are effective in the treatment of depression. These trials typically focus on the effects of treatments on depressive symptoms, response, and remission. But when patients seek treatment, is a reduction of depressive symptoms really what they want, or do patients have other goals as well? This is a highly relevant question, not only because there is a growing recognition of the importance of patient-defined outcomes and the need to involve people with lived experience in research and clinical practice. Another important development is that the diagnostic systems, especially the DSM and ICD, have been increasingly criticized. Depressive disorders are not clear entities with objective tests to establish whether a patient has such a disorder or not. There are also no clear thresholds for when a patient has a disorder and when not. Depression is a highly heterogeneous disorder with many different, widely varying symptom patterns, and high levels of comorbidity with anxiety, substance use, personality, and other mental disorders. The hundreds of randomized trials examining the effects of treatment have included patients meeting criteria for depressive disorders, and have shown that these treatments have modest, but significant effects on depression. However, if depression is not such a clear entity as the diagnostic systems suggest, but instead a highly heterogeneous mix of many different symptom patterns and other disorders, can we be really sure that we are focusing on the right outcomes? From this perspective, it would be wise to take a step back and have a closer look at what patients need when they seek treatment.