Delayed response & recurrence

This graph shows the typical time course in patients with depression. One of the critiques of the monoamine hypothesis of depression is the fact that there is a significant delay in relief of depressive symptoms (most respond after a few weeks). This is in contrast to the relative quick effect the drugs have on their targets (effects seen within hours). In addition, some patients may suffer from a relapse despite taking antidepressant therapy.

Although one should always consider non-compliance as the cause, these quick relapses are often caused by failures in antidepressant therapy. Recurrences are common and are found in 50-70% of the patients who have previously suffered from a depressive episode. When a recurrence occurs, antidepressant therapy may need to be restarted or if the patient is on maintenance therapy, changed to another agent.

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Response, resistance, relapse, recurrence, and recovery are the 5 R's of depression.

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