Improving Clinician-Patient Communication Alleviates Stigma in Patients With Functional Dyspepsia Receiving Antidepressant Treatment

Abstract

Background/AimsAntidepressants are effective in patients with functional dyspepsia (FD). However, stigma associated with FD and antidepressants may affect treatment adherence. This study aims to explore possible communication strategies to alleviate stigma and improve adherence in patients with FD. MethodsIn this randomized, single-center, and single-blind trial, 160 patients with FD initiating antidepressant treatment were recruited. Different communication strategies were performed when prescribing antidepressants. Participants in Group 1 were told that brain is the "headquarters" of gut, and that antidepressants could act as neuromodulators to relieve symptoms of FD through regulating the functions of gut and brain. Participants in Group 2 were told that antidepressants were empirically effective for FD. Stigma scores, medication-related stigma, treatment compliance, and efficacy were analyzed. ResultsAfter 8-week antidepressant treatment, the proportion of patients with FD with decreased stigma scores in Group 1 was significantly higher than in Group 2 (internalized stigma: 64.10% vs 12.00%; perceived stigma: 55.13% vs 13.33%; P < 0.01). Medication-related stigma was lower in Group 1 than in Group 2 (P < 0.05 for 3 of 4 questions). Concurrently, patients in Group 1 had better treatment compliance (0.71 ± 0.25 vs 0.60 ± 0.25, P < 0.01) and efficacy. In Group 1, participants with decreased post-treatment stigma scores showed better treatment compliance and efficacy than those with non-decreased scores. Decrease in stigma scores positively correlated with treatment compliance. ConclusionImproving knowledge of patients with FD of the disease and antidepressants via proper communication may be an effective way to alleviate stigma and promote adherence.

Short-course antidepressant therapy reduces discontinuation syndrome while maintaining treatment efficacy in patients with refractory functional dyspepsia: A randomized controlled trial

“…The education was provided by experienced gastroenterologists through clinician-patient communication. It could establish patients' understanding of the disease and alleviate their concerns about the drug, which has been reported in our previous research (36): (1) Brain is the "controller" of GI tract, and the FD symptoms are caused by disorders of gut-brain interaction, rather than a sole GI or psychological problem; (2) Neuromodulators are used to relieve FD symptoms through regulating functions of GI tract and brain, which mainly acts on peripheral nervous system; (3) Neuromodulators are used in FD at lower doses and shorter courses, which is different from psychiatry patients. Lifestyle suggestions were as follows: (1) Maintain regular sleep (37); (2) Keep regular meal patterns, and eat a balanced low-fat diet with more vegetables and fruits (38)(39)(40); (3) Recommend aerobic physical exercise for 150-300 min per week (41).…”

“…The results showed that 2-week FM treatment obtained comparable efficacy to 4-week FM treatment with fewer ADS and adverse effects in patients with rFD. This research could provide practical advice for gastroenterologists when treating FD patients who are worried about antidepressant dependence ( 11 , 36 ).…”

“…Patients' stigma and wrong perceptions of medications and disease could hinder treatment efficacy ( 58 ). It has been reported that effective communication of the rationale of the brain-gut axis, benefits of neuromodulators or behavioral health treatments could improve patient satisfaction and clinical outcomes ( 33 , 36 , 58 , 59 ). Behavioral therapy, such as maintaining a low-fat diet, regular sleep, and moderate exercise, was reported to be beneficial in relieving FD symptoms ( 37 – 40 ).…”

Clinical Trial: Efficacy of Mosapride Controlled-release and Nortriptyline in Patients With Functional Dyspepsia: A Multicenter, Double-placebo, Double-blinded, Randomized Controlled, Parallel Clinical Study

“…Neuromodulators such as antidepressants, antipsychotics, and other central nervous system-targeted medications are widely used in patients with EPS. 13 - 16 The most widely accepted mechanism of neuromodulation is based on the deficiency of 1 or more monoamines, such as serotonin (5-HT), noradrenaline, and dopamine, in patients with FD. 16 , 17 However, PDS predominates among FD patients in Asia.…”

Stigma and Efficacy of Zhizhu Kuanzhong Capsules Versus Doxepin in the Treatment of Refractory Functional Dyspepsia: A Randomized Controlled Trial

“… 13 In a previous study, we found that proper explanation of the mechanisms for neuromodulators to patients may alleviate stigma and improve treatment adherence for rFD. 14 These studies indicate that patients’ different comprehensions of therapeutic drugs may influence stigma and thus affect treatment compliance and efficacy in the treatment of DGBI. 2 , 10 , 13 , 14 Exploring more treatment therapies is of great significance to reduce patients’ stigma and improve their medication compliance.…”