Compliance: the impact of adverse events and tolerability on the physician's treatment decisions

A hidden factor that can influence patient compliance is the physician's concern about the tolerability and safety of prescribed medication. Patients may complain about medication side effects that are unpleasant but not dangerous, and this in itself may decrease patient compliance. However, physicians' awareness about adverse events may influence the choice of a drug, and patients' adherence to treatment. In the acute phase of treatment there is a concern about the suicide potential of the depressed patient. The tricyclic antidepressants (TCAs) are toxic in overdose, in contrast to the relative safety of the SSRIs, SNRIs and mirtazapine. Safety issues are also a concern during long-term treatment with antidepressants, i.e., during the continuation and maintenance phases of treatment. Long-term effects such as weight gain and sexual dysfunction distinguish different classes of antidepressants. A particular clinical challenge is the situation when antidepressant medication is administered to a patient with a comorbid medical illness treated with other drugs. This occurs frequently in elderly patients, and may result in an increase in adverse events and/or drug-drug interactions. Therefore, one strategy to determine the usefulness of a medication is to study its efficacy, tolerability and adverse events in a vulnerable population. Data from a recently completed open study of mirtazapine orally disintegrating tablets in depressed nursing home patients indicate that it was effective and well tolerated. This study used an orally disintegrating tablet formulation (Remeron SolTab), which was well received by both the patients and staff. Data on patient preferences in another open outpatient study looking at patients at least 50 years of age showed that patients also preferred mirtazapine orally disintegrating tablets to conventional tablets, and indicated that they would be more likely to comply with a prescription for an orally disintegrating tablets than conventional tablets.