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Limits to chemotherapy of depression.

A large number of depressed patients are undiagnosed and therefore untreated. A substantial proportion of those patients who are treated are allegedly 'refractory', 'resistant' or 'non-responsive' to anti-depressant drug therapy. Definitions and criteria for the use of these terms vary, or are totally lacking, and incidence figures in the literature vary between 10 to 50%. In addition, 3 to 15% of depressed patients otherwise satisfactorily treated suffer unwanted effects. Such observations clearly illustrate limits to successful antidepressive therapy. Some of these may require new approaches on the part of medical education or further research and development of psycho-active drugs on existing lines. However, the limitations imposed by the unwanted effects of antidepressives are more tangible and might be substantially influenced when manufacturers actively and succinctly inform the medical profession about changes in the ADR profiles of their products. As an example, the evolution of the ADR profile of the antidepressant maprotiline is demonstrated: the frequency of reports on convulsions in association with maprotiline treatment in the USA and the UK decreased about four-fold and seven-fold respectively after appropriate adjustments of daily-dose ranges were recommended.