J Korean Soc Biol Psychiatry.  2001 Jun;8(1):37-46.

Difficult Clinical Problems of Treatment in Depression

• Min KJ

Abstract

Whenever a clinician manages the patients with depression, he may meet various prolems that make it difficult to treat them. Even though he has good skills and knowledge abut depression, some barriers will be appear during his practice. In general, the difficulties in treating depression are treatment-resistance, adverse effects of antidepressants, pregnancy in female patients, comorbid medical conditions, poor compliance, drug-drug interactions, and so on, which are related with pharmacological treatments. Here, only the two of them, the treatment-resistant depression and difficult problems concerned with pregnancy, were discussed. Some level of treatment resistance is the norm rather tnan the exception. As the treatment failure stems from inadequate treatment, it is important that the clinician should prescribe medications with sufficient doseage and adequate duration. And to overcome the treatment resistant depression the polypharmacy is necessary, in that case, the side effects and toxicities should be explored and managed immediately. So the clinician have to learn more about the pharmacokinetic and pharmacodynamic mechanisms of each drugs used in treatment of depression. When the risk of the fetus by the exposure is higher than the risk of untreated maternal psychiatric disorder, psychotropic medications should be used durig pregnancy. Women who are maintained on psychotropics and become pregnant, as well as women with the new onset of psychiatric symptoms durig pregnancy, should be carefully reassessed. However, data concerning the potential risk of long-term behavioral changes folowing prenatal exposure to psychotropics is rare, so further longitudinal follow-up studies are needed.

MeSH Terms

Antidepressive Agents
Compliance
Depression*
Depressive Disorder, Treatment-Resistant
Female
Fetus
Humans
Polypharmacy
Pregnancy
Treatment Failure
Antidepressive Agents