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Related Experiment Videos

Tolerability and adherence issues in antidepressant therapy.

Prakash S Masand1

  • 1Program for Continuing Medical Education, Duke University Medical Center, Durham, North Carolina 27710, USA. masan001@mc.duke.edu

Clinical Therapeutics
|September 27, 2003
PubMed
Summary

High rates of antidepressant nonadherence persist due to physician, patient, and medication factors. Optimizing antidepressant therapy requires addressing these issues to improve adherence and treatment outcomes.

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Area of Science:

  • Psychiatry
  • Pharmacology

Background:

  • High recurrence (80%) and treatment failure (40-60%) rates in depression underscore treatment challenges.
  • Significant patient nonadherence to antidepressant therapy is evident, with many discontinuing treatment within months.

Purpose of the Study:

  • To review research on antidepressant therapy nonadherence.
  • To analyze limitations of strategies aimed at minimizing adverse events and extending treatment duration.

Main Methods:

  • Comprehensive literature search (1990-present) using databases like MEDLINE.
  • Keywords included: tolerability, antidepressants, compliance, adherence, SSRIs, tricyclics.

Main Results:

  • Physician factors (education, dosage, follow-up) and patient factors (motivation, perceived benefit, cost) significantly impact adherence.

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  • Medication issues (adverse events, dosing complexity, delayed efficacy) also contribute to discontinuation.
  • Combining antidepressants or using atypical antipsychotics shows limited evidence for efficacy and safety.

    • Conclusions:

    • Maximizing antidepressant adherence necessitates adequate treatment duration and realistic patient expectations.
    • Selecting the right agent and dosage to manage symptoms and control adverse events is crucial for sustained therapy.