At ECNP 2022, Dr Charlotte Emborg discussed how people with major depressive disorder (MDD) often have insight into their condition but recovery may be slowed down by cognitive dysfunction and/or hampered by substance abuse problems. Discussion is needed to help a patient understand the need to remain on medication to more fully return to how they were prior to MDD onset. Treatment considerations should take into account both clinical efficacy and side-effects and, in drug-naïve patients especially, psychoeducation regarding potential short- and long-term side-effects is key to help maintain drug adherence. Cognitive function may take longer to respond to medication than mood disorder symptoms of MDD and patients need counselling to understand the impact of such symptoms and how time is needed for all aspects of MDD to resolve.