Compliance and therapeutic issues in resistant depression.

It is generally accepted that as many as 30% of depressed patients fail to respond to treatment with standard antidepressive pharmacotherapy. Surveys have revealed that as many as 25% of depressed patients are given inappropriate treatment. Furthermore, several studies have shown that non-compliant patients can represent as many as 20% of resistant patients. If this is confirmed, the generally accepted rate of 30% of depressed patients defined as resistant to antidepressive pharmacotherapy could be overestimated. A comprehensive review of treatment aspects and patient characteristics in treatment-resistant depression has shown that the most important factors to consider are the use of elevated doses over long periods and treatment tolerance. The severity of the disease, comorbidity with Diagnostic and statistical manual of mental disorders Axis I and Axis II diagnoses and chronic disorders are among the key patient variables. However, all these parameters are also important for patient compliance in the treatment of depression. Therefore, the problem of compliance should be considered during all treatment phases in treatment-resistant patients, and strategies aimed at optimizing compliance may have important implications for the management of treatment-resistant depression.