[Between response and resistance: pseudo-resistance during treatment of major depressive disorder]

Although the efficacy of antidepressants has been clearly established, 30-60% of patients with major depressive disorder (MDD) appear to have a poor response. However, many patients labeled with treatment-resistant depression actually have pseudo-resistance due to suboptimal approach.

To provide an overview of the causes of pseudo-resistance, as well as the interventions to counteract it in patients with MDD.

A literature search was conducted using the PubMed, Embase, and Web of Science databases.

The causes of pseudo-resistance can be multiple and can be attributed to both the clinician (inappropriate prescribing behavior, misdiagnosis or incomplete diagnosis) and the patient (ultra-fast metabolism, poor medication adherence, comorbidity). Advice and interventions to prevent pseudo-resistance must therefore be targeted to the clinician (knowledge of clinical guidelines, simplified dosage schedules, correct diagnosis, interventions to improve poor medication adherence), as well as the patient (personalized psychoeducation, social support, care management).

Pseudo-resistance is a multifactorial phenomenon that requires complex intervention strategies. In addition to adequate treatment provided by the clinician, personalized psychoeducation, good patient support and intensive follow-up of, as well as open communication with the patient are also required.