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Notes
- Despite the availability
of more than 20 approved antidepressant drugs, treatment outcome is
unsatisfactory for many patients. Hyman, 1995:58-59.
- Approximately
20% to 40% of patients diagnosed with a major depressive disorder do
not respond to their initial antidepressant agent. Joffe, 1996:25(1)
- Approximately
20% to 30% experience partial response (eg, 50% improvement in depressive
symptoms). Joffe, 1996:25(1)
- Partial response
may leave a patient with substantial morbidity if the depression
was originally severe. Phillips, 1994:20 (2); Joffe, 1996:25 (1)
- Delays in antidepressant
onset of several weeks occur in most patients.
- Recurrence of
depression while still on medication (breakthrough) can also occur.
Fava, 1995:52 (1)
- Several factors
can contribute to treatment failure, including undiagnosed or misdiagnosed
medical conditions, unrecognized comorbid disorders, and undiagnosed
depression subtypes. Phillips, 1994:21 (4)
- Hypothyroidism,
anemia, neurologic disorders, and consumption of such nonpsychiatric
drugs as antihypertensive agents can cause or exacerbate depression.
Phillips, 1994:21 (5)
- The more familiar
comorbid disorders include substance abuse or dependence, eating
disorders, and personality disorders. Obsessive compulsive disorders,
body dysmorphic disorder, and olfactory reference syndrome can also
affect treatment response. Phillips, 1994:22 (1)
- Psychotic
depression, bipolar depression, and atypical depression are depressive
subtypes that may respond differently to antidepressants than uncomplicated
major depression. Phillips, 1994:22 (3)
- Side effects and
poor compliance (eg, discontinuation or treatment refusal) are additional
obstacles to successful treatment.
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