Management of treatment nonresponse

Abstract

Inadequate treatment response is unfortunately a common problem. Approximately 50–70% of patients gain significant benefit from treatment but, of these, not all will have symptomatic remission [1]. An approximate rule of thirds applies, with a third achieving remission, a third being significantly better but not symptom free with partial remission, and a third remaining depressed. These proportions depend on the duration of follow-up and the nature of the population being studied. Consideration of next-step treatments is therefore extremely important and a pessimist might say that the next step should be planned at the time of the first step. It is certainly important to plan treatment in the knowledge that further steps might be needed.