Table 7.1.

Factors Contributing to Poor Response to Initial Treatment.

Clinical factors

Treatment factors

Incorrect diagnosis (e.g., bipolar disorder) Demographic and illness characteristics (e.g., older age, female sex, younger age of onset, higher severity, increased number/duration of episodes, and trauma history) Psychiatric medical comorbidities (e.g., anxiety disorders, personality disorders, attention-deficit hyperactivity disorder, substance use disorders, etc.) Nonpsychiatric medical comorbidities (e.g., anaemia, obesity, sleep apnea, thyroid disease, etc.) Acute or chronic stressors

Inadequate dose of treatment Inadequate duration of treatment Side effects masking as symptoms Poor adherence to treatment Pharmacogenetic variability (e.g., rapid or slow metabolism of drugs)