Correspondingly, the decrease in the final score may be ascribed to the improvement/disappearance of the typical depressive signs (eg, mood, anhedonia, guilt, suicidal ideation, psychic signs, and retardation), which is significant on clinical grounds, or to the alleviation of accessory symptoms (eg, anxiety, appetite, insomnia, sexual interest, and somatic symptoms), which is of limited value. Further,

adverse effects of treatments (eg, sleepiness or sedation) may decrease the total score of the rating scale, producing an Vemurafenib purchase artificial improvement.15 As important is the target, of the instruments employed. For instance, Inhibitors,research,lifescience,medical in a naive conceptualization, yet the one implicitly endorsed by DSM-III and DSM-IV, well-being and distress may be seen as mutually exclusive (ie, wellbeing is lack of distress). Yet, there is evidence Inhibitors,research,lifescience,medical to call such views into question.17-19 As a result, the appraisal of recovery may rest on purely symptomatic grounds,1 or may be extended to perceptions (levels of well-being and satisfaction with life), or be expanded to functional capacity (the ability to perform activities of Inhibitors,research,lifescience,medical daily life, social and intellectual function, economic status). This latter tridimensional assessment may be subsumed

under the rubric of quality of life.17 Measurement, may also Inhibitors,research,lifescience,medical be extended to biological variables, which tend to subside upon clinical recovery and may accompany both prodromal and residual symptomatology and constitutes a psychobiological risk for relapse. Such markers may include abnormalities of

the hypothalamic-pituitary-adrenal (HPA) axis,20,21 impaired lymphocyte glucocorticoid sensitivity, 22 and abnormal sleep electroencephalographic Inhibitors,research,lifescience,medical (EEG) patterns. 23,27 The more sensitive and multidimensional the tools employed, the more arbitrary the nature of the recovery which emerges. Residual symptoms The notion that the majority of depressed patients experience mild but chronic residual symptoms or recurrence of symptoms after complete remission, which was well delineated in the 1970s,28 did not receive the attention it deserved in subsequent years. Such a phenomenon was emphasized, in Idoxuridine fact, mainly in its etiological role regarding dysthymia. Subsyndromal residual symptoms of major depressive disorder continued to be regarded as minor fluctuations unworthy of clinical attention. However, the literature describing the presence of residual symptoms after completion of drug treatment of major depression and their clinical implications in terms of poor long-term outcome continue to grow29-43 Residual subthreshold symptoms were also reported after completion of psychotherapy.