Compliance with antidepressants in a primary care setting, 1: Beyond lack of efficacy and adverse events.

BACKGROUND

Treatment guidelines recommend antidepressant treatment be continued for at least 6 months to ensure maximal improvement and to prevent relapse. Naturalistic studies show that the average length of treatment is shorter than 6 months and that dropout rates are high. Factors leading patients to discontinuation of therapy are not well understood. This study investigates when and why patients stop treatment and whether they inform their doctors.

METHOD

Patients (N = 272) receiving antidepressant therapy due to an episode of major depressive disorder (DSM-IV) were asked to complete an antidepressant compliance questionnaire. Patients were then telephoned monthly while they continued on antidepressant therapy, up to 6 months. During each call, patients were asked standard questions.

RESULTS

By endpoint, 53% of patients had discontinued antidepressant treatment. The most common reason given was "feeling better." However, different dropout reasons were prevalent at different times after initiation of therapy. Overall, 24% of the patients did not inform their physician about stopping the antidepressant medication. The likelihood of patients' informing their physicians differed according to the patients' reasons for discontinuation and according to the patients' perceptions of their relationship with their physicians.

CONCLUSION

These results provide new guidelines for improving compliance. Strategy should be adapted to the stage of treatment, as patients' reasons for discontinuation vary as treatment progresses. The attitude of the physician and the information provided by the physician significantly influence whether patients inform the physician when they discontinue antidepressant therapy.