Supporting depressed patients
Addressing adherence

Despite the fact that depression is one of the leading causes of disability worldwide, and that antidepressant therapy is essential for positive patient outcomes, many patients remain non-adherent to their prescribed treatment plan.1,2 To quantify the scale of non-adherence in depression:

  • Almost half of outpatients who are prescribed an antidepressant discontinue treatment within the first month2,3
  • Up to 68% of patients with depression discontinue treatment within 3 months, depending on the medication prescribed2
  • Less than a third of patients with depression receive and
    take their medication appropriately2

 

What’s causing this?

The reasons for this potential non-adherence differ between patients. However, a number of factors could be contributing to a patient’s non-compliance with therapy, including:2

  • Treatment-related adverse events
  • Unawareness of the importance of adhering to treatment, even if they feel better
  • Cognitive dysfunction, including difficulties with memory and concentration
  • Feelings of hopelessness
  • Greater focus on relieving somatic symptoms
  • Stigmas surrounding depression, particularly regarding weakness
  • Feelings that treatment is not deserved
  • Lack of reassurance
  • Lack of continuity of care
  • Complex treatment regimens
  • Cost of treatment
  • Dissatisfaction with treatment response
  • Chronic illness
  • Perceived lack of a friendly relationship with healthcare professional

How can you help?

Some practising healthcare professionals recommend that an optimal method to address potential adherence difficulties when treating patients with depression is through a collaborative approach to their care. Working together can help to reinforce a positive physician-patient relationship, and provide insights into the patient’s priorities for treatment outcomes. This, in turn, can provide motivation for the patient to comply with treatment, in pursuit of change that is both helpful and important to them.4

Additionally, the provision of education regarding the importance of compliance in antidepressant treatment can improve patient adherence to therapy. One randomised, controlled, prospective study found that the administration of a monthly, mail-based education programme about antidepressant medications had a positive influence on patients’ compliance with treatment.5

Even the introduction of simple and specific educational messages about antidepressant treatment and adherence into appointments have been shown to enhance compliance with therapy, at least in primary care settings.6 Above all, it is essential to emphasise the importance of continuing with treatment to patients with depression, even after improvement or cessation of symptoms.

References
  1. World Health Organisation. Depression Factsheet Number 369. Available at: http://www.who.int/mediacentre/factsheets/fs369/en/. Accessed July 2015.
  2. Bucci KK et al. Strategies to improve medication adherence in patients with depression. Am J Health-Syst Pharm 2003; 60: 2601-2605.
  3. Whooley MA, Simon GE. Managing depression in medical outpatients. New England Journal of Medicine 2000; 343(26): 1942-1950.
  4. Culpepper L. Cognition in MDD: implications for primary care. In: Cognitive dysfunction in Major Depressive Disorder. Ed: McIntyre R, Cha D, 2015.
  5. Hoffman L et al. Impact of an antidepressant management program on medication adherence. Am J Manag Care 2003; 9(1): 70-80.
  6. Lin EHB et al. The role of the Primary care Physician in Patients’ Adherence to Antidepressant Therapy. Medical Care 1995; 33(1): 67-74.
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