64 Many patients whose symptoms do not disappear completely are considered resistant to treatment, although, strictly

speaking, this is a pseudoresistance that can be caused by insufficient dosage, insufficient treatment time, poor adherence, or clinical evolution.65 Depression is an illness that is difficult to treat due to its inherent characteristics, factors that affect the prescription of medication and proper treatment (such as poor SB431542 molecular weight adherence and low dosage), comorbidity, and ineffective treatment.66 Inhibitors,research,lifescience,medical A great deal of the enormous personal, social, and economic cost brought on by depression is due to poor social functioning, which has generally been underestimated. While there are differences among the various treatments available to achieve better social functioning, it must be recognized than an improvement in symptoms docs not necessarily Inhibitors,research,lifescience,medical ensure better functioning in society67 or at work.68 Factors affecting adherence The arsenal of antidepressants available is much larger today, and the new medications are as efficient as the old tricyclics and monoamine oxidase inhibitors (MAOIs), but with fewer side effects. Although information on the diagnosis and treatment Inhibitors,research,lifescience,medical of

depression has been publicized in the media, nonadherence to therapy continues to be a major problem. Little research has been done into the factors associated with noncompliance in treatment for affective disorders, and nonadherence in unipolar and bipolar disorders has been estimated to range from 10% to 60%.69,70 Adherence studies using patients’ self-reports show that patients tend to overestimate their compliance, especially older subjects.71 A patient’s beliefs Inhibitors,research,lifescience,medical about the illness, unpleasant side effects, ineffective treatment, and cultural factors arc all variables in noncompliance.72 Among teenagers prescribed imipramine, it was determined that the oppositional defiant

disorder and family dysfunction Inhibitors,research,lifescience,medical affected adherence to the medication, rather than the side effects.73 The latency period in the early stages of medication and poor tolerance Carnitine palmitoyltransferase II for antidepressants have an effect on compliance.74 In addition, the physician’s initial communication style significantly influences a patient’s attitude toward the usefulness of antidepressants.75 Patients’ attitudes and beliefs about the illness and treatment have proven to be as effective in predicting adherence as the unpleasant side effects of the drugs.69,70 Treatment with selective serotonin reuptake inhibitors (SSRIs) is abandoned less frequently than therapy with conventional and modern tricyclics, but the difference is small and is based on short-term, controlled, randomized trials. Therefore, in clinical practice, generalizations cannot be made about a greater adherence to SSRIs.