The Decision-Making Process of Antidepressant Use Among Patients with Depression: A Grounded Theory Study

To explore how patients with depression and prior antidepressant use make decisions about antidepressant treatment and to construct a theoretical model from their perspectives.

A constructivist grounded theory study was conducted. Semi-structured in-depth interviews were undertaken with 26 patients with depression who had used antidepressants for at least one continuous treatment period of one month or longer, including current users and those who had discontinued medication. Data were collected through iterative theoretical sampling and analyzed using open, axial, and selective coding until theoretical saturation was achieved.

The core process was conceptualized as "Weighing the Pros and Cons: Navigating Between the Quagmire of Illness and the Hope of Treatment." This process comprised three dynamic, non-linear stages: decision trigger, active evaluation, and dynamic adaptation. Decision-making was initiated when patients' tolerance threshold was broken by internal distress and/or external prompts, including authoritative advice. During active evaluation, patients balanced the perceived necessity of medication as a "chemical lever" against concerns about stigma, side effects, alienation, and dependence. Trust in physicians and individualized benefit-cost-risk trade-offs shaped initial decisions. During dynamic adaptation, medication-taking behaviors formed a continuum from strict adherence and negotiated self-adjustment to avoidance-oriented or distress-driven discontinuation. Treatment feedback continuously reshaped subsequent decisions.

Antidepressant decision-making is a dynamic process of sense-making and negotiation. The findings suggest that not all non-adherence should be interpreted as strategic self-management, highlight authoritative third-party advice as a trigger for treatment initiation, and indicate that identity tension may shape some patients' medication experiences during long-term adaptation.