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Opinion paper: poor response to treatment of depression in people in high occupational levels

Published online by Cambridge University Press:  12 October 2018

Laura Mandelli
Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
Alessandro Serretti*
Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
Stefano Porcelli
Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
Daniel Souery
Laboratoire de Psychologie Médicale, Université Libre de Bruxelles and PsyPluriel, Brussels, Belgium
Julien Mendlewicz
Université Libre de Bruxelles, Brussels, Belgium
Siegfried Kasper
Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
Stuart Montgomery
Imperial College, University of London, London, UK
Joseph Zohar
Expert Platform on Mental Health, Focus on Depression Tel-Aviv University Israel, Tel-Aviv, Israel
Author for correspondence: Alessandro Serretti, E-mail:


The working environment may have a significant effect on response to treatment of depression and this issue has not yet been sufficiently addressed in the scientific literature. There is evidence showing that being engaged in high-level positions can be an obstacle to the success of treatment. This article discusses the few evidence in the literature and some of the possible mechanisms involved. Specific personality attributes and difficulties in adapting to depression may delay access to care and may also reduce treatment compliance. The presence of stress in jobs that require high cognitive function and lack of social support may be elements that hinder the recovery process. Residual symptoms that impact on cognitive functions may undermine adherence to treatment and adversely affect the response. The implications of these issues are potentially relevant for clinical practice in the treatment of depression and for future research.

Copyright © Cambridge University Press 2018 

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