Identifying patients with depression who require a change in treatment and implementing that change.

Creating an effective treatment regimen for patients diagnosed with major depressive disorder (MDD) can be a challenge for clinicians. With each treatment trial, only 20% to 30% of patients achieve remission, and many of those who do reach remission experience residual symptoms. Patients with treatment-resistant depression or with residual symptoms are candidates for a change in treatment. Other patients requiring treatment changes are those who experience intolerable adverse effects and those who experience an illness recurrence. Because early detection can lead to improved outcomes, clinicians must be vigilant about assessing patients to identify when one or more of these situations occur. Clinicians must also communicate effectively with their patients to ensure that they understand the treatment strategies, goals, and potential adverse effects; have realistic expectations of treatment; and express their treatment preferences. Timely and appropriate treatment adjustment is necessary to help patients with MDD achieve recovery.