Hospital Patients' Perceptions During Treatment and Early Discontinuation of Serotonin Selective Reuptake Inhibitor Antidepressants

Abstract

Studies have suggested that discontinuation of treatment in depressed patients is associated with their perceptions about their treatment. We surveyed 403 adults treated for major depressive disorder with a selective serotonin reuptake inhibitor (SSRI) 3 months after onset of treatment to assess their interactions with clinicians, reasons they stopped SSRI treatment, and SSRI side effects (SEs). Bothersome SEs, poorer instruction by physicians about SSRI SEs, and self-reported change in depression, sex, marital status, and employment were significantly (P < 0.05) associated with discontinuation. Logistic regression examined the associations between patients' perceptions during treatment planning and SSRI discontinuation. Seventeen percent of patients felt uninvolved in treatment decisions, 9% disagreed with the diagnosis, and 24% subsequently stopped treatment. Elevated risk of discontinuation was found among patients who felt uninvolved in treatment decisions (unadjusted risk ratio [RR], 2.3; 95% confidence interval [CI], 1.2-4.3) and those who disagreed with the diagnosis (RR, 2.0; CI, 0.9-4.4). Patients who both felt uninvolved and disagreed with the diagnosis were 7-fold as likely to discontinue their SSRI (RR, 7.3; CI, 1.5-36.3) compared with those who felt neither uninvolved nor disagreed. Selective serotonin reuptake inhibitor SEs, specific interactions with clinicians, self-assessed outcomes, and sociodemographics did not explain these associations. To improve adherence to medications, clinicians should consider patients' perceptions about their involvement in treatment decisions and agreement with their diagnosis.

Antidepressant Adherence Across Diverse Populations and Health Care Settings

“…12,[32][33][34] We also found that patients living in neighborhoods with lower levels of education had lower rates of antidepressant adherence, and although some studies found similar results, 28,34 others did not find education to have an effect. 29,30,35 In our population, patients with higher comorbidity burden were more likely to adhere to their antidepressant medications, perhaps due to a learning effect, having a routine for consistently taking medications, or having a better understanding of the negative effects of stopping chronic disease medications. Other studies have found mixed effects for the impact of disease burden on medication adherence, with some finding improved adherence in patients with greater comorbidity, 36,37 and others finding no effect or decreased adherence.…”

“…12 However, only four of the 32 studies analyzed the effects of race on adherence, and three of these were fairly small, with sample sizes between 390 and 403, and reliant on self-reports of adherence. [28][29][30] Two studies found no differences between racial/ethnic groups, but their minority patient samples were fairly small, at 134 and 143 patients each. 29,30 The third study found that Hispanic patients were less adherent than non-Hispanic white patients (OR=0.58, 95% CI: 0.36 to 0.94), while adherence rates for blacks and an "other" racial/ethnic group were similar to non-Hispanic whites.…”

“…[28][29][30] Two studies found no differences between racial/ethnic groups, but their minority patient samples were fairly small, at 134 and 143 patients each. 29,30 The third study found that Hispanic patients were less adherent than non-Hispanic white patients (OR=0.58, 95% CI: 0.36 to 0.94), while adherence rates for blacks and an "other" racial/ethnic group were similar to non-Hispanic whites. 28 The fourth and final study had a larger sample size (N=3083) and used prescription records to assess adherence, a more reliable indicator of prescription refills.…”

Measurement issues of shared decision making in mental health: challenges and opportunities

“…In summary, data on convergent/discriminant validity are needed to better delimitate the proposed constructs. Finally, existing evidence about the predictive performance of measures of SDM on behavioral (adherence, self-management) and health outcomes (symptoms, health-related quality of life) is scarce, but some significant positive associations have been found (Loh, Simon, et al 2007;Clever et al 2006;Woolley et al 2010). The significant impact that mental health problems have on distinct life areas also highlight the importance of patients' social support, and in this sense the involvement of caregivers, family, or parents of young patients in the process of care and decision making seems crucial to increases the quality of services and maximize clinical improvement and quality of life.…”

Performance improvement CME in psychiatry: implementing black box warning informed consent

“…This activity addressed a number of factors in the doctor-patient relationship and prescribing process that are IoM priorities and which are known to enhance pharmacologic treatment outcomes. These factors include involvement in medical decision making, [32][33][34] good communication, [35][36][37] and providing information about side effects. 26 There are a number of potential limitations with regard to this research.…”