NONCOMPLIANCE WITH ANTIDEPRESSANTS - WHOS TO BLAME

Compliance with medical advice has always been a problem and there has always been discussion on who is to blame for noncompliance: the illn ess, the physician, the patient or the drug? A consensus between the p hysician's beliefs, views and representations of the nature and the et iology of the depression and of the treatment options on the one hand and the patient with his individual life story on the other is probabl y the best guarantee of reasonable compliance. In particular, a physic ian-patient consensus about the emotional meaning of the illness is es sential: patients should be given the opportunity to express their fee lings about the illness and what it signifies, and physicians should r espond with feedback using the patient's concepts and emotional expres sion. Within this context of dialogue, patients may signal their resis tance to and potential noncompliance with the physician's views. An em pathic model of understanding can be used in the initial stages of the consultation. Finding an equilibrium between the cognitive-informatio nal aspects of depressive illness and treatment on one hand and affect ive-motivational aspects on the other is a key factor in antidepressiv e treatment. Physicians should indeed always try to overcome the gap b etween the affective (empathy, motivational aspects) and the instrumen tal dimensions (correct diagnosis, adequate treatment) of their behavi or. (C) 1998 Rapid Science Ltd.