ABSTRACT
It is often optimistically estimated that 60-80% of persons with depression will respond to an antidepressant. The reality of treating depression is much more complex and often entails polypharmacy. The estimate of up to 80% response rate with depression is based on randomized clinical trials, which frequently are not generalizable to the real-world setting. In the real world, the treatment of depression can be complicated by substance abuse, medication noncompliance, and anxiety comorbidity, all conditions screened out of clinical trials. Further, clinical trials are usually of short duration (less than 2 months), and patients sometimes lose some or all of their benefit with an antidepressant medication over time. Clinical trial definitions of response with an antidepressant are also usually based on 50% or more improvement in depression rating scale scores. In clinical practice, such individuals, though improved, continue to have significant symptoms or may not have recovered functionally (at work and interpersonally).
