Explaining Patients' Beliefs About the Necessity and Harmfulness of Antidepressants

Abstract

PURPOSEPatients' beliefs about antidepressants vary widely and probably infl uence adherence, yet little is known about what underlies such beliefs. This study's objective was to identify the demographic and clinical characteristics that account for patients' beliefs about antidepressants.METHODS Participants were 165 patients with unipolar nonpsychotic major depression from primary care and psychiatry clinics who were participating in the baseline phase of a multistaged trial of medication and psychotherapy. Before patients started antidepressants, interview and self-report measures were used to assess treatment beliefs, depression features, and comorbid conditions. Linear multivariate regression was used to identify the strongest correlates of perceived medication necessity and harmfulness after adjusting for age, sex, education, and the random effects of patients within clinical site. RESULTSPerceived necessity was associated with older age (P <.001), more severe symptoms (P = .03), longer anticipated duration of symptoms (P = .001), and attribution of symptoms to chemical imbalance (P = .005). Perceived harmfulness was highest among patients who had not taken antidepressants before (P = .02), attributed their symptoms to random factors (P = .04), and had a subjectively unclear understanding of depression (P = .003). Neither belief was signifi cantly associated with sex, education, age at fi rst depressive episode, presence of melancholia or anxiety, psychiatric comorbidity, or clinical setting.CONCLUSIONS Skepticism about antidepressants is strongest among younger patients who have never taken antidepressants, view their symptoms as mild and transient, and feel unclear about the factors affecting their depression. Perhaps these patients would benefi t the most from adherence promotion focusing on treatment beliefs. INTRODUCTIONA lthough depression treatment guidelines recommend continuation of medication for at least 8 months after symptom remission, [1][2][3] 50% to 83% of patients prescribed antidepressants either discontinue their medication prematurely or take it too inconsistently to derive any clinical benefi t, 4-6 which appears to increase their risks for relapse and recurrence. [7][8][9] A large body of literature indicates that patients' beliefs and attitudes about medication predict medication adherence, treatment outcome, or both-in general 10 and in depression. 4,5,[11][12][13] Our prior study of 573 primary care patients indicated that the only identifi able baseline predictor of early discontinuation was beliefs about the appropriateness of taking medication for depression. 11 In another study of patients who were well established in the maintenance phase of antidepressant therapy, we found patient beliefs about antidepressant necessity vs harmfulness to be the only identifi able correlate of adherence.14 In neither study did demographic or depression characteristics account for adherence.Despite 24 PAT IEN T S' BEL IEF S A B OU T A N T IDEPR ES S A N T Santidepressant beliefs. Beca...

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