‘Just keep taking the tablets’: adherence to antidepressant treatment in older people in primary care

Maidment, Rachel; Livingston, Gill; Katona, Cornelius

doi:10.1002/gps.688

Cited by 101 publications

(62 citation statements)

References 25 publications

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“…[12][13][14][15] Contrary to this finding, this study suggests that at least those patients who are on long-term medication have little apprehension in taking antidepressants. As attitudes to antidepressants are not fixed and can change over time, it is possible that any initial apprehension is forgotten as antidepressants become an accepted treatment.…”

Section: Comparison With Existing Literaturecontrasting

confidence: 95%

Long-term prescribing of antidepressants in the older population: a qualitative study

Dickinson

Knapp²,

House³

et al. 2010

Br J Gen Pract

124

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MethodThirty-six patients aged ≥75 years and 10 GPs were interviewed. Patients were sampled to ensure diversity in age, sex, antidepressant type, and home circumstances. ResultsParticipants perceived significant benefits and expressed little apprehension about taking long-term antidepressants, despite being aware of the psychological and social factors involved in onset and persistence of depression. Barriers to discontinuation were identified following four themes: pessimism about the course and curability of depression; negative expectations and experiences of ageing; medicine discontinuation perceived by patients as a threat to stability; and passive (therapeutic momentum) and active (therapeutic maintenance) decisions to accept the continuing need for medication. ConclusionThere is concern at a public health level about high rates of long-term antidepressant prescribing, but no evidence was found of a drive for change either from the patients or the doctors interviewed. Any apprehension was more than balanced by attitudes and behaviours supporting continuation. These findings will need to be incorporated into the planning of interventions aimed at reducing long-term antidepressant prescribing in older people. Keywordsantidepressants; prescribing; attitudes. INTRODUCTIONA previous study of antidepressant prescribing in the UK reported high rates of long-term prescribing. For patients aged ≥75 years, 14% were being prescribed an antidepressant, while the rate in those aged <75 years was less than half that (6%). 1Among patients aged ≥75 years prescribed an antidepressant, almost half (48%) had been in receipt of a prescription for more than 2 years. Few patients' records had evidence of medication review or discussion of possible withdrawal.Depression is common in later life, 2,3 but it is not clear why the rates of prescribing, and of long-term prescribing in particular, appear to be so much higher in patients aged ≥75 years. 4 Most older patients with depression are managed in primary care by their GP. Guidance regarding the management of depression in the UK is provided by the National Institute for Health and Clinical

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Section: Comparison With Existing Literaturecontrasting

confidence: 95%

Long-term prescribing of antidepressants in the older population: a qualitative study

Dickinson

Knapp²,

House³

et al. 2010

Br J Gen Pract

124

View full text Add to dashboard Cite

show abstract

“…By endeavoring to take this approach to the consultation it may increase patient confidence in the prescriber. In this way patients may feel able to voice their concerns about medicines and improve intentional adherence patterns (Barber et al, 2004, Maidment et al, 2002, Belcher et al, 2006. In this respect the nurses with prescribing roles can play a pivotal role and make a significant impact on the lives of older people through structured medication assessment and education (Griffiths et al, 2004).…”

Section: Discussionmentioning

confidence: 99%

“…Also the recognition of adverse effects (Conrad, 1985, Lumme-Sandt et al, 2000, Hughes, 2004, Maidment et al, 2002, Kippen et al, 2005. The anticipation of drug-related side effects and general dislike of taking medicines are common causes of intentional non-adherence (LummeSandt et al, 2000).…”

Section: Perceptions and Attitudes To Medication Adherence And Non-admentioning

confidence: 99%

Older people and adherence with medication: A review of the literature

Banning

2008

International Journal of Nursing Studies

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“…Factors previously associated with non-adherence include being male 7 ; less fear of illness, not living with a relative 8 ; adverse effects, poor instructions, patients' disagreement with the need for treatment 9 and cost difference in adherence between the younger and the oldest old 10 . Trials of interventions to improve adherence so far have been disappointing 9,15 .…”

Section: Introductionmentioning

confidence: 99%