Compliance With Antidepressants in a Primary Care Setting, 1: Beyond Lack of Efficacy and Adverse Events.

Background: Treatment guidelines recommend antidepressant treatment be continued for atleast 6 months to ensure maximal improvement and to prevent relapse. Naturalistic studiesshow that the average length of treatment is shorter than 6 months and that dropout rates arehigh. Factors leading patients to discontinuation of therapy are not well understood. This studyinvestigates when and why patients stop treatment and whether they inform their doctors.Method: Patients (N = 272) receiving antidepressant therapy due to an episode of major depressive disorder (DSM-IV) were asked to complete an antidepressant compliance questionnaire.Patients were then telephoned monthly while they continued on antidepressant therapy,up to 6 months. During each call, patients were asked standard questions. Results: By endpoint,53% of patients had discontinued antidepressant treatment. The most common reason givenwas “feeling better.” However, different dropout reasons were prevalent at different times afterinitiation of therapy. Overall, 24% of the patients did not inform their physician about stoppingthe antidepressant medication. The likelihood of patients’ informing their physicians differedaccording to the patients’ reasons for discontinuation and according to the patients’ perceptionsof their relationship with their physicians. Conclusion: These results provide new guidelinesfor improving compliance. Strategy should be adapted to the stage of treatment, as patients’ reasons for discontinuation vary as treatment progresses. The attitude of the physician andthe information provided by the physician significantly influence whether patients inform thephysician when they discontinue antidepressant therapy.