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Article includes commentary by Andreas H. Schenk. Under-treatment of depression is common practice and carries substantial risks of relapse and recurrence while increasing morbidity and mortality in co-morbid medical illnesses. It may also lead to or exacerbate structural brain changes in depression, most particularly in the hippocampus, with an accompanying decline in cognitive functioning. Treatment to full remission of symptoms and maintaining patients in remission is therefore essential. Although all current antidepressants seem to provide comparable efficacy in preventing relapse, some of the newer dual action antidepressants can induce a faster response and produce greater degrees of remission. However, remission rates are low even with the best treatments. There remains a need for treatments that will act quickly to reverse not only the symptoms of depression but also the accompanying brain abnormalities. SA Psychiatry Rev. Vol.7(3) 2004: 5-9

Depression may be associated with hippocampal volume changes and HPA axis dysfunction: is treatment to remission the answer?: review article