Patients' views of antidepressants: from first experiences to becoming expert

Abstract

BackgroundThe majority of patients discontinue antidepressant treatment earlier than prescribed. The factors behind this and the influences on patients' choices about whether to take medication remain poorly understood. AimTo explore factors that influence patients' decisions about taking antidepressant medication. Design of studyQualitative interview study. SettingInterviews were conducted across three sites: London, East Lancashire, and North East England. MethodSemi-structured interviews were conducted with a purposive sample of 65 primary care patients who were prescribed antidepressants in the past year for depression or mixed anxiety/depression. ResultsParticipants described their first course of antidepressants as typically occurring when they had 'hit rock bottom', having exhausted all other possibilities; therefore, there was little sense of a positive choice at this stage. There would typically follow a period of experimentation where it was usual to stop and restart medication, often several times. Ultimately, these recurring cycles lead to participants becoming more expert about their condition and better able to make an informed decision about medication. For younger participants, recovery typically remained a goal, although for older people there was often an acceptance that their condition, and medication use, would be long term. ConclusionParticipants' accounts demonstrated how they could become expert at managing their condition through a process of trial and error.

Patients' expectations of medicines – a review and qualitative synthesis

“…Medicines as an instrumental way to relieve both specific and wide-ranging aspects of symptomatic illness are elicited by patients with depression needing to get better quickly after 'hitting rock bottom' 23 and epilepsy, where the medicines control seizures as well as reduce worry. 10 Preventive medications are also seen as providing very specific benefits such as 'stopping a heart attack' or 'curing the bones'.…”

“…Patients describe both their own views, those of family members and reports available in the public realm as negatively influencing usage of medicines. 23,37 The number of medicines used by one person is also reported as something that may be valued negatively and evoke criticism from others. Patients question the helpfulness of taking a large number of medicines every day 27 and may decline new suggested therapies on the basis that they are already using too many medicines.…”

“…Fear of getting addicted, associations with illicit substance use 23,37 Hesitancy to be dependent on medicines for a normal life…”

“…Medicines for different conditions are seen as being of different value 38 Patients with the same condition express diametrically different views about the treatment: necessary or of very limited value; as something that helps to live normally or the only way to avoid death; as a choice based on experience or a resignation in lack of other options 23,25,37 Core health beliefs and notions of responsibility and morality influence decisions Patients' expectations of medicines, U Dohnhammar, J Reeve and T Walley shorter time-scale when determining whether a medicine has beneficial effects. Their acceptance of risks or symptoms in relation to sideeffects and the number of aspects weighted into decisions also make patients' decision making different from that stipulated by a biomedical model of health and illness.…”

“…However, such negative notions can be overcome by acquiring knowledge about a condition: Steroids form an essential part of the management of asthma, and medication against depression or epilepsy becomes accepted as a way to get on with life. 10,23,37 A number of authors address the question about whether medicines are seen as necessary for life, health, etc. or if usage is optional, subject to personal inclination and should be balanced with life style changes to help manage the condition.…”