PMID- 14512135
OWN - NLM
STAT- MEDLINE
DCOM- 20040108
LR  - 20220318
IS  - 0149-2918 (Print)
IS  - 0149-2918 (Linking)
VI  - 25
IP  - 8
DP  - 2003 Aug
TI  - Tolerability and adherence issues in antidepressant therapy.
PG  - 2289-304
AB  - BACKGROUND: Despite the availability of effective antidepressants, recurrence and 
      relapse rates for depression are high (up to 80%), treatment failures are common 
      (40% to 60%), and as many as 20% of patients remain inadequately treated. 
      Depression treatment guidelines are often not followed, and rates of nonadherence 
      to treatment are high, with 28% of patients discontinuing antidepressant 
      treatment within the first month and 44% discontinuing within 3 months of 
      initiating therapy. OBJECTIVE: The aim of this article was to summarize research 
      on antidepressant therapy nonadherence and examine the limitations of strategies 
      used to minimize adverse events (AEs) and improve treatment duration. METHODS: A 
      thorough search of the published literature from 1990 to the present was 
      performed on MEDLINE and other search engines. The following search terms were 
      used: tolerability, antidepressants, patient compliance, adherence, therapy, 
      SSRIs, tricyclics, and other related terms focusing on specific agents. RESULTS: 
      Physician-specific issues represent some of the most important obstacles to 
      adequate antidepressant therapy. Inadequate patient education, prescription of 
      inappropriate medications or inadequate dosages, and lack of follow-up care are 
      all issues the physician can control to improve patient adherence. 
      Patient-specific issues include poor motivation (due to symptoms of depression) 
      to continue therapy, failure to perceive a benefit, and concerns about cost of 
      therapy. Medication-specific issues such as treatment-related AEs, delayed onset 
      of action, complicated dosing or titration schedule, and subtherapeutic dosing 
      also contribute to treatment discontinuation. Therapy with >/=I antidepressant 
      and/or atypical antipsychotic may improve symptom control, but little evidence 
      exists regarding efficacy and safety. Dosage reduction has been attempted to 
      reduce events that may lead to patient discontinuation, but this may increase the 
      risk of recurrent depressive episodes. CONCLUSIONS: To maximize patient adherence 
      to antidepressant therapy, it is necessary to combine adequate treatment 
      duration, realistic patient expectations, and the right dose of an agent capable 
      of treating the full range of symptoms while controlling for AEs.
FAU - Masand, Prakash S
AU  - Masand PS
AD  - Program for Continuing Medical Education, Duke University Medical Center, Durham, 
      North Carolina 27710, USA. masan001@mc.duke.edu
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
PT  - Review
PL  - United States
TA  - Clin Ther
JT  - Clinical therapeutics
JID - 7706726
RN  - 0 (Antidepressive Agents)
SB  - IM
MH  - Antidepressive Agents/administration & dosage/adverse effects/*therapeutic use
MH  - Clinical Trials as Topic
MH  - Depressive Disorder/*drug therapy
MH  - Dose-Response Relationship, Drug
MH  - Drug Therapy, Combination
MH  - Humans
MH  - Patient Compliance
MH  - Practice Patterns, Physicians'
RF  - 58
EDAT- 2003/09/27 05:00
MHDA- 2004/01/09 05:00
CRDT- 2003/09/27 05:00
PHST- 2003/09/27 05:00 [pubmed]
PHST- 2004/01/09 05:00 [medline]
PHST- 2003/09/27 05:00 [entrez]
AID - S0149291803802205 [pii]
AID - 10.1016/s0149-2918(03)80220-5 [doi]
PST - ppublish
SO  - Clin Ther. 2003 Aug;25(8):2289-304. doi: 10.1016/s0149-2918(03)80220-5.