DEPRESSION AND ANXIETY 00:1–5 (2012) Research Article WHY DO SOME DEPRESSED OUTPATIENTS WHO ARE NOT IN REMISSION ACCORDING TO THE HAMILTON DEPRESSION RATING SCALE NONETHELESS CONSIDER THEMSELVES TO BE IN REMISSION? Mark Zimmerman, M.D., 1,2∗ Jennifer Martinez, B.A., 1,2 Naureen Attiullah, M.D., 1,2 Michael Friedman, M.D., 1,2 Cristina Toba, M.D., 1,2 and Daniela A. Boerescu, M.D. 1,2 Background: In treatment studies of depression, remission is typically defined narrowly—based on scores on symptom severity scales. Patients treated in clini- cal practice, however, define the concept of remission more broadly and consider functional status, coping ability, and life satisfaction as important indicators of remission status. In the present report from the Rhode Island Methods to Im- prove Diagnostic Assessment and Services (MIDAS) project, we examined how many mildly symptomatic depressed patients in ongoing treatment who did not score in the remission range on the 17-item Hamilton Depression Rating Scale (HAMD) nonetheless considered themselves to be in remission from their de- pression. Among the mildly symptomatic HAMD nonremitters, we compared the demographic and clinical characteristics of patients who did and did not con- sider themselves to be in remission. Methods: We interviewed 274 psychiatric outpatients diagnosed with DSM-IV major depressive disorder who were in on- going treatment. The patients completed measures of psychosocial functioning and quality of life. Results: Approximately one-quarter of the patients scoring 8–12 on the HAMD considered themselves to be in remission. Compared to pa- tients who did not consider themselves to be in remission, the remitters reported significantly better quality of life, less functional impairment due to depression, higher positive mental health scores, and better coping ability. Discussion: Some patients who do not meet symptom-based definitions of remission nonetheless consider themselves to be in remission. The findings raise caution in relying ex- clusively on symptom-based definitions of remission to guide treatment decision making in clinical practice. Depression and Anxiety 00:1–5, 2012. C  2012 Wiley Periodicals, Inc. Key words: depression; remission; Hamilton Rating Scale for Depression 1 Department of Psychiatry and Human Behavior, Brown Medi- cal School, Providence, Rhode Island 2 Department of Psychiatry, Rhode Island Hospital, Providence, Rhode Island Conflicts of interest. None. Funding/support: The research was supported, in part, by Eli Lilly USA, LLC. ∗ Correspondence to: Mark Zimmerman, Bayside Medical Center, 235 Plain Street, Providence, RI 02905. E-mail: mzimmerman@lifespan.org Experts recommend remission as the primary goal in the treatment of depression. [1–9] The implication of rec- ommendations to “treat till remission” is that treatment should be modified until remission is achieved. Received for publication 15 December 2012; Revised 2 July 2012; Accepted 7 July 2012 DOI 10.1002/da.21987 Published online in Wiley Online Library (wileyonlinelibrary.com). C  2012 Wiley Periodicals, Inc.