Five Interpersonal Factors Are Predictive of the Response to Treatment of Major Depression With Antidepressants in Primary Care

Abstract

Introduction: Factors relating to the interpersonal relationship between the patient and their physician and social environment are important components, which contribute to their response to treatment for major depressive disorder. This study aimed to assess the influence of optimism, perfectionism, therapeutic alliance, empathy, social support, and adherence to medication regimen in the response to antidepressant treatments in the context of normal primary care clinical practice.Method: We conducted a prospective study in which 24 primary care physicians administered sertraline or escitalopram to 89 patients diagnosed with major depressive disorder. The response to treatment and remission of the episode was assessed at 4 and 12 weeks by Cox regression. The effect of adherence to the medication regimen was assessed by multiple regression statistical techniques.Results: Adherence to medication (HR = 0.262, 95% CI = 0.125–0.553, p < 0.001) and patient perfectionism (HR = 0.259, 95% CI = 0.017–0.624, p < 0.01) negatively predicted the initial response to treatment, whereas patient optimism (HR = 1.221, 95% CI = 1.080–1.380, p < 0.05) positively predicted it. Patient optimism (HR = 1.247, 95% CI = 1.1–1.4, p < 0.05), empathy perceived by the patient (HR = 1.01, 95% CI = 1001–1002, p < 0.05), and therapeutic alliance (HR = 1.02, 95% CI = 1001–1.04, p < 0.05) positively predicted episode remission, while patient perfectionism (HR = 0.219, 95% CI = 0.093–0.515, p < 0.001) and low adherence to the treatment regimen (HR = 0.293, 95% CI = 0.145–0.595, p < 0.001) negatively predicted it. Finally, social support (p < 0.01) and therapeutic alliance (p < 0.05) predicted adherence to the medication regimen.Conclusions: In addition to taking the antidepressant drug, other factors including the personal interactions between the patient with their primary care physician and with their social environment significantly influenced the patients' initial response and the final rate of episode remission.

Effectiveness of direct contact intervention with people with mental illness to reduce stigma in nursing students

“…The relationship between the professional and the user has been described as one of the main elements for treatment adherence, as long as it takes place in a collaborative environment, far from coercion, in which the needs of the person are considered (Salazar‐Fraile et al . ). To create this therapeutic alliance, the fear or the desire to avoid, typical stigmatizing attitudes, should not be present.…”

“…Through the intervention based on direct contact described, carried out during their training, we believe that future nurses could enter professional practice with a lower burden of stigmatizing attitudes, thus facilitating the creation of therapeutic alliance, one of the most important tools for successful outcomes (Martin et al 2000). The relationship between the professional and the user has been described as one of the main elements for treatment adherence, as long as it takes place in a collaborative environment, far from coercion, in which the needs of the person are considered (Salazar-Fraile et al 2018). To create this therapeutic alliance, the fear or the desire to avoid, typical stigmatizing attitudes, should not be present.…”

A qualitative emancipatory inquiry into relationships between people with mental disorders and health professionals

“…A good therapeutic alliance can improve the symptoms and functioning of people with mental disorders (Kreyenbuhl et al., 2009; Priebe et al., 2011; Salazar‐Fraile et al., 2018; Shattock et al., 2017). Some studies have suggested that the therapeutic alliance is an essential element for increasing the effectiveness of pharmacological or psychological treatments (Horvath et al., 2011).…”

Does Culture Influence Antidepressant Response? A Preliminary Investigation of Randomized Controlled Trials of Fluoxetine

“…There are several mechanisms that may have mediated this association. First, there is some evidence to suggest that hierarchical cultures with a high power distance may be associated with greater peer support [ 33 ] and a clearer sense of “belonging” [ 34 ]; these factors have been associated with a better response to antidepressants in earlier analyses [ 14 , 16 ]. Second, in such cultures in individuals in a position of “less power” (in this case, patients participating in a trial of antidepressants) have higher levels of trust in those considered to have “more power” (in this case, doctors or researchers) [ 35 ].…”