Antidepressant treatments have evolved over the last 20 years, and many new drugs with complex mechanisms of action are available. It has become apparent that mechanism of action is significant in terms of treatment impact. We may have some capacity to predict the potential outcomes of treatment based on what drugs we use. Depression management requires elaborate assessment in order to keep track of treatment progress and know how to move through the sequences of therapy. Many patients with depression who are treated with antidepressants do not experience full remission, and a large number of patients who do recover eventually relapse. Remission as a treatment goal is difficult to achieve. One of the reasons why remission rates are low is that the currently available treatment choices are implemented improperly. Also, our understanding of the neurobiology of depression is still in the early stages. As we gain more knowledge about what this disorder truly entails, we will be able to achieve better treatment outcomes, and we can hope that remission will become the standard of care in treating patients with depression. © 2001, Cambridge University Press. All rights reserved.