Optimizing outcomes in depression: focus on antidepressant compliance.

Major depressive disorder is a chronic and recurrent illness that is associated with significant morbidity and mortality. Patients frequently experience recurrent depressive episodes that are of longer duration and increased severity and which are less responsive to treatment than the index episode. Despite the highly prevalent nature of the illness, depression is frequently unrecognized and undertreated. Compliance with antidepressant medication is essential to consolidate treatment response and prevent relapse and recurrence. However, compliance with antidepressant medication is poor. Education of the patient and physician regarding the nature of depression and its treatment is essential for improving patient compliance. Although psychological mechanisms are a major factor affecting patient compliance, speed of onset of action and poor tolerability of antidepressant medication also have a considerable influence on patient compliance. The newer antidepressants, such as selective serotonin reuptake inhibitors, nonselective serotonin-norepinephrine reuptake inhibitors, and the selective norepinephrine reuptake inhibitors, are better tolerated than tricyclic antidepressants, possibly resulting in improved compliance and treatment outcome.