Compliance and acceptance in antidepressant treatment

Poor compliance with antidepressant medication is widespread in both primary care and psychiatric practice, and is a major obstacle to the effective management of depression. It is often believed that adverse events and a lack of efficacy associated with inappropriate prescribing of older antidepressants are common reasons why patients discontinue treatment prematurely. However, appropriate prescribing of effective and well-tolerated antidepressants does not necessarily guarantee compliance. A patient's core beliefs and attitudes to treatment also influence the chances of successful management, and studies have shown that patients harbour many unfounded beliefs relating to antidepressant medications and their use. The prescribing physician is therefore duty bound not only to ensure that they chose an effective antidepressant with minimal side-effects and prescribe it according to treatment guidelines, but that they actively explore the patient's beliefs and attitudes at the time of treatment. Addressing common misconceptions about antidepressant medications, and undertaking a structured follow-up, have been shown both to enhance compliance and improve treatment outcomes. The choice of newer, more selective antidepressants results in a higher number of patients achieving at least one month of treatment. The choice of a drug with a once-daily treatment regimen (drugs with a longer half-life) and with a low risk for discontinuation symptoms if doses are occasionally missed is also warranted. ( Int J Psych Clin Pract 2001; 5 (Suppl 1): S29-S35).