Over at PsychCentral, Dr. Grohol has a post regarding previous and current thinking about reasonable goals for the treatment of depression. He cites research that indicated people in treatment for depression don't get better "as quickly, or as easily, as previously thought." He further discusses some recent thoughts about whether remission of depression is a reasonable goal.
The post is very solid, and I like the points Dr. Grohol raises. First, while I do think that there is often a tendency in research to rely too much on self-report, I don't understand why a study would not at least include self-report of depressed symptoms as part of the outcome data. As Dr. Grohol states, "I’m always a little critical of studies that choose to use clinician-based measures over patient-based measures (why not use both and be certain?), because it means we’re measuring outcomes based upon the clinicians’ criteria (judgment and biases), not the patients’. You could very well have clinicians rating a person as no longer being clinically depressed, but the patient’s self-report could say otherwise." There are a number of problems with relying solely on the opinion of a clinician regarding whether a client is improving, not the least of which are: A) You aren't the one who's depressed, and; B) Clinicians have a self-serving interest in believing that their interventions are effective (there, I admitted it!).
I also agree with Dr. Grohol's statement that in the real world, most treatment plans do not specify "Complete Eradication of Target Depression!" as their goal. Rather, we seek to reduce symptomatology in bits and pieces, usually trying to first a address one or two significant, but manageable (from a treatment perspective) symptoms, and periodically re-evaluating from there. Part of the problem may be the false hope that some clients have from taking a pill (hopefully in addition to therapy) that will "cure" their depression. But any clinician worth their salt will be educating their clients on the benefits and limitations of the medication being prescribed, including dispensing with the idea that once an antidepressant reaches a therapeutic level in the system, their depression is "cured."
I also think it is actually quite reasonable to expect, and to educate a client up front, that effective treatment for issues such as depression often depend on finding the right mix - of clinician, therapy type/interventions, medication, etc. - and that there may be some bumps in the road before obvious progress is made. When treating mental health issues becomes as simple as treating a broken bone, I'll be the first to jump for joy. In the meantime, it's important to occasionally remind oneself that the brain is a significantly more complicated organ than a bone, and that a cast just won't cut it...