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Treating to target in major depressive disorder: response to remission to functional recovery

机译：针对重度抑郁症的治疗：缓解对功能恢复的反应

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Treating to target in chronic diseases [e.g. Major Depressive Disorder (MDD)] fosters precision, consistency, and appropriateness of treatment selection and sequencing. Therapeutic target definitions/endpoints in MDD should satisfy patient-, provider-, and societal expectations. Functional recovery in depression and return to both physical and mental health are the overarching therapeutic objectives. Treating to target in MDD implies multidimensional symptomatic remission, with a particular emphasis on cognitive function and aspects of positive mental health. Several atypical antipsychotic agents (i.e. brexpiprazole, aripiprazole, quetiapine) are FDA-approved as augmentation agents in MDD. Vortioxetine, duloxetine, and psychostimulants have evidence of independent, direct, and robust effects on cognitive function in MDD. Vortioxetine is the only agent that demonstrates efficacy across multiple cognitive domains in MDD associated with functional recovery. Measurement-based care, health information technology/systems, and integrated care models (e.g. medical homes) provide requisite tools and health environments for optimal health outcomes in MDD. Achieving remission in MDD does not equate to health. Return to positive mental health as well as full functioning provide the impetus to pivot away from traditional provider-defined outcomes toward an inclusive perspective involving patient-and society-defined outcomes (i.e. optimization of human capital). As in other chronic diseases, treating to target (e.g. cognitive function) further increases the probability of achieving optimal health outcomes.
机译：治疗以慢性疾病为目标[例如重度抑郁症（MDD）可提高治疗选择和排序的准确性，一致性和适当性。 MDD中的治疗目标定义/终点应满足患者，提供者和社会的期望。抑郁症的功能恢复以及身心健康是首要的治疗目标。在MDD中治疗靶标意味着多维症状缓解，尤其强调认知功能和积极的心理健康。 FDA批准了几种非典型抗精神病药（即brexpiprazole，aripiprazole，quetiapine）作为MDD中的增强剂。伏替西汀，度洛西汀和精神刺激药对MDD的认知功能具有独立，直接和强大的作用。伏替西汀是唯一在与功能恢复相关的MDD中跨多个认知域显示功效的药物。基于度量的护理，健康信息技术/系统和综合护理模型（例如医疗之家）为MDD中的最佳健康结果提供了必要的工具和健康环境。在MDD中实现缓解并不等于健康。恢复积极的心理健康以及充分发挥功能，推动了从传统的提供者定义的结果转向包括患者和社会定义的结果（即人力资本优化）的包容性观点的动力。与其他慢性病一样，针对目标（例如认知功能）进行治疗会进一步增加获得最佳健康结果的可能性。

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