Recognizing the drug-resistant patient in anxiety and depression

The number and variety of anxiolytic and antidepressant medications available to the modern clinician lend an unparalleled efficacy to the outpatient treatment of anxiety disorders and depression. Where diagnosis is precise and complicating organic factors have been excluded, true treatment resistance in either anxiety disorders or depression is rare. Proper patient education to assist compliance, adequate dosage of individual agents, patience to give the medication time to work, overcoming the reluctance to attribute the patient's problem to a medically treatable disorder rather than to moral or characterologic defect, and the flexibility to shift to other or to additional medications on encountering initial treatment resistance are the keystones to the successful management of more than 90 per cent of all cases.