Antidepressant
discontinuation as a result of ineffective
communication between patient and
physician
For
an effective long-lasting treatment of
depression, guidelines recommend continuing
antidepressant therapy for 4 to 9 months after
the acute recovery to prevent relapse. However
many patients stop taking their medication too
early usuaslly within 3 months.
A survey was conducted to assess the effect of
the relationship between the patient-physician
communication and long-term compliance with
antidepressants, treatment response, adverse
effects and frequency of follow-up visits.
Four hundred and one depressed patients treated
with a selective serotonin reuptake inhibitor
(SSRI) and 137 prescribing physicians
participated in the survey. Therapy duration,
adverse effects, therapy discontinuation or
medication switching within 3 months after the
start of SSRI treatment were the items of
communication between the patient and
physician.
Seventy-two percent of physicians reported that
they asked patients to take their SSRI for at
least 6 months, but only 34% of patients
reported being told this while 56% reported
having received no instructions at all. Patients
who reported being told to take their medication
for less than 6 months were more than 3 times as
likely to discontinue therapy in comparison with
those who said they were asked to continue
treatment longer. A lower risk
of
therapy
discontinuation was associated with a discussion
between the patient and physician of adverse
effects of the drug. Switching medications was
more common when the adverse effects were
discussed. Less than 3 follow-up visits for
depression, lack of of therapeutic response, and
the occurence of adverse effects were factors
associated with treatment discontinuation.
This survey shows that the instructions given by
physicians do not always correspond to what the
patients remembers hearing. Physicians need to
insist and repeatedly explain the reasons for
the duration of long-term therapy and the
possible adverse effects of a medication in
order to avoid discontinuation of SSRI use. More
frequent visits to the physician will help the
patient not to forget the information given
during the initial visit and to reinforce their
willingness to continue treatment. JAMA
288: 1403-1409, 2002