Noncompliance with antidepressants: who's to blame?

Compliance with medical advice has always been a problem and there has always been discussion on who is to blame for noncompliance: the illness, the physician, the patient or the drug? A consensus between the physician's beliefs, views and representations of the nature and the etiology of the depression and of the treatment options on the one hand and the patient with his individual life story on the other is probably the best guarantee of reasonable compliance. In particular, a physician-patient consensus about the emotional meaning of the illness is essential: patients should be given the opportunity to express their feelings about the illness and what it signifies, and physicians should respond with feedback using the patient's concepts and emotional expression. Within this context of dialogue, patients may signal their resistance to and potential noncompliance with the physician's views. An empathic model of understanding can be used in the initial stages of the consultation. Finding an equilibrium between the cognitive-informational aspects of depressive illness and treatment on one hand and affective-motivational aspects on the other is a key factor in antidepressive treatment. Physicians should indeed always try to overcome the gap between the affective (empathy, motivational aspects) and the instrumental dimensions (correct diagnosis, adequate treatment) of their behavior.