Dell'Osso Bernardo, Albert Umberto, Carrà Giuseppe, Pompili Maurizio, Nanni Maria Giulia, Pasquini Massimo, Poloni Nicola, Raballo Andrea, Sambataro Fabio, Serafini Gianluca, Viganò Caterina, Demyttenaere Koen, McIntyre Roger S, Fiorillo Andrea
Department of Biomedical and Clinical Sciences "Luigi Sacco", University of Milan, Milan, Italy.
Department of Mental Health, ASST Fatebenefratelli-Sacco, Milan, Italy.
Ann Gen Psychiatry. 2020 Oct 12;19:61. doi: 10.1186/s12991-020-00306-2. eCollection 2020.
Studies conducted in primary care as well as in psychiatric settings show that more than half of patients suffering from major depressive disorder (MDD) have poor adherence to antidepressants. Patients prematurely discontinue antidepressant therapy for various reasons, including patient-related (e.g., misperceptions about antidepressants, side-effects, and lack of tolerability), clinician-related (e.g., insufficient instruction received by clinicians about the medication, lack of shared decision-making, and follow-up care), as well as structural factors (e.g., access, cost, and stigma). The high rate of poor adherence to antidepressant treatments provides the impetus for identifying factors that are contributing to noncompliance in an individual patient, to implement a careful education about this phenomenon. As adherence to antidepressants is one of the major unmet needs in MDD treatment, being associated with negative outcomes, we sought to identify a series of priorities to be discussed with persons with MDD with the larger aim to improve treatment adherence. To do so, we analyzed a series of epidemiological findings and clinical reasons for this phenomenon, and then proceeded to define through a multi-step consensus a set of recommendations to be provided by psychiatrists and other practitioners at the time of the first (prescription) visit with patients. Herein, we report the results of this initiative.
在初级保健以及精神科环境中进行的研究表明，超过一半的重度抑郁症（MDD）患者对抗抑郁药的依从性较差。患者因各种原因过早停止抗抑郁治疗，包括与患者相关的原因（例如，对抗抑郁药的误解、副作用和耐受性差）、与临床医生相关的原因（例如，临床医生对药物的指导不足、缺乏共同决策和后续护理）以及结构因素（例如，可及性、成本和污名）。抗抑郁治疗依从性差的高比例促使人们去识别导致个体患者不依从的因素，以便针对这一现象进行仔细的教育。由于对抗抑郁药的依从性是MDD治疗中主要未满足的需求之一，且与负面结果相关，我们试图确定一系列优先事项，以便与MDD患者进行讨论，其更大的目标是提高治疗依从性。为此，我们分析了这一现象的一系列流行病学发现和临床原因，然后通过多步骤的共识确定了一组建议，供精神科医生和其他从业者在首次（开处方）就诊时向患者提供。在此，我们报告这项举措的结果。
