La risposta subottimale al trattamento antidepressivo: definizione e implicazioni cliniche

Abstract

Introduction

Insufficient responses to antidepressant drugs can be an important problem, with negative clinical and psychosocial consequences.

Materials and methods

On the basis of an extensive analysis of the existing literature, the authors provide a possible operational definition of suboptimal treatment response and review the available data on the frequency of this phenomenon and its implications.

Results

A suboptimal response to antidepressant therapy is defined as a partial response or one that includes residual sub-threshold symptoms. These responses are associated with an increased risk for recurrence/relapses, shorter times to recurrence/relapse, higher risks of disease chronicity and suicidal tendencies, reduced functioning, and increases in the costs of care. Suboptimal responses are observed in approximately 70% of all patients after the first cycle of treatment, but with repeated attempts at treatment, this rate drops to approximately one third of cases.

Conclusions

Given their frequency and negative consequences, suboptimal responses to antidepressant therapy can be a challenge for clinicians, and complex strategies (e.g., augmentation, add-on, or switching) are often needed to overcome the limitations of the treatment.