Giving up on Antidepressants
One of the essential elements of medical treatment is that the patient takes their medication. Why then do so many people choose not to follow medical advice and simply throw in the towel part way into their treatment? We're not just talking about minor ailments, some people with the most chronic conditions are the worst culprits.
Depression affects people at different levels of severity. The first line of treatment is nearly always antidepressant medication, yet research indicates that as few as 25 percent actually continue with their treatment for more than 11 months. Most patients, according to researchers from the Catalan Institute of Health (ICS), give up on antidepressants within the first four months. Men, it appears, are the worst culprits with 50 percent giving up after just two months. Women last a little longer, with 50 percent stopping after three months. Similar findings have been reported in earlier studies.
There are a variety of reasons why this might happen. We know, for example, that many cases of depression improve spontaneously after a period of around three months. So it may be the case that certain people have a fairly mild case of depression in the first instance. It is also known that antidepressant medication tends to be more effective in cases of very severe depression. To some extent the research seems to support the fact that people with more chronic cases of depression, and who are taking multiple medications, are twice as likely to stick with their treatment.
It tends take several weeks before the therapeutic effects of antidepressant medication is felt. Some people may simply give up because of impatience, or because they dislike the side effects associated with the medication they are taking. Others may be so-called ‘treatment resistive' which implies there is something about them that won't allow the medication to work. More mundane reasons may be down to forgetfulness or simply not understanding the perceived importance of taking regular doses at their prescribed times.
Several researchers have highlighted the importance of communication in improving treatment adherence. Studies have shown impressive results with some fairly simple techniques involving the way information in structured. For example:
- Patients tend to remember the first thing they are told so stress the importance of taking medication regularly and consistently early in the consultation.
- Keep the information simple.
- Repeat the important stuff.
- Follow up with one or more appointments.
- Written information handed to the patient by the doctor (as opposed to the standard literature that comes with the pills) is also said to help.
Matthew Keene, MD, writing for MedscapeCME, talks about the 3Cs of noncompliance: confusion, costs and complaints. Confusion, he states, stems partly from unrealistic expectations about immediate results, but also problems with recalling information or having had lack of clear instructions. So far as costs are concerned, Keene points out that "in the world of the underinsured or uninsured, even small costs can be an insurmountable barrier to compliance." Some of the most common complaints and associated reasons for giving up on medication are side effects, with nausea, headache, drowsiness, and an increased feeling of anxiety leading the list of complaints.
As Keene suggests, addressing the 3Cs may not eliminate antidepressant noncompliance but it's one step in the right direction.
FECYT - Spanish Foundation for Science and Technology. "More than half of depression patients give up their treatment." ScienceDaily 22 November 2010. 23 November 2010 <http://www.sciencedaily.com /releases/2010/11/101122111510.htm>.
Matthew S, Keene. "Confusion and Complaints: The True Cost of Noncompliance in Antidepressant Therapy." Medscape Psychiatry & Mental Health. 10.2 (2005): n. pag. Web. 23 Nov 2010.