Outcome measures are (too) often driven by what regulatory bodies request and stick to observer rated depression scales. It is already known that self rating and observer rating scales are not always concordant but recent research even indicates that what physicians and patients expect from outcome is not the same. Physicians put a lot of emphasis on (mainly) depressive symptoms not taking into account the often comorbid anxiety and somatic symptoms while patients put more emphasis on positive mood (vigor, energy, optimism) and on feeling the usual self. Moreover, research indicates that the divergence between physicians’ and patients’ expectations also influence outcome. These differences, how they manifest and what can be done to overcome them so as to provide satisfactory outcomes of treatment, will be further discussed.