Such patients are then likely to mislabel pretreatment symptoms as drug-related after starting antidepressants. Other patients refuse psychotherapy because they believe that it will be too intrusive, complicated, lengthy, expensive or overly focused on experiences from childhood. When patients begin treatment, some may be dissuaded by unexpected or unpleasant side effects of the medications, delay in sufficient improvement or difficulty in forming an alliance with a psychotherapist. Patients may also be reluctant to visit a mental health subspecialist, even if such services are available. Patients who initially agree to treatment must follow the treatment plan closely to ensure improvement of the illness.
Many patients stop taking their medications within the first month of treatment.
According to the AMA council, patient education improves the likelihood of adherence to treatment in patients with depression. This has been proved in almost every study in which it has been examined. The differences between outcomes of adherent and nonadherent patients are considerable, equal to the difference between the use of an active antidepressant and a placebo. In some cases, physicians cannot appreciate the duration or severity of a depression and may take an inappropriately expectant approach. Even when physicians decide that treatment is needed, they may prescribe antidepressants in inadequate dosages or for periods of time that are not of sufficient duration to be effective.