Engaging Patients with Depression in Treatment Continuity

When conceptualising engagement with treatment, it may be useful to contrast ‘disease’, which refers to underlying psychobiological dysfunction, with ‘illness’, which describes the experience of the person with that disease. Knowledge of disease, as well as understanding of illness, including patients’ explanatory models of symptoms, may be useful in facilitating shared decision-making. Ideally, physicians are able to integrate evidence-based medicine with values-based medicine by combining the best research evidence with patients’ unique needs and preferences. This, in turn, requires taking a systematic approach to the assessment of a range of domains (i.e. symptom profile, clinical subtype, severity and comorbidity) in individuals with depression, and individualising treatment accordingly. While data are now available from a range of randomised clinical trials addressing treatments for depressive symptoms, it is also notable that a decrease in symptom severity does not necessarily correlate with an increase in functioning, which highlights the need to monitor patients for the effect of treatment on a range of outcomes including comorbid anxiety, emotional responsiveness, and sleep quality. Importantly, recent epidemiological data emphasise the importance of persistence with treatment; most patients with major depression who persist with treatment eventually feel helped.