How to improve adherence to antidepressant treatments in patients with major depression: a psychoeducational consensus c
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nals of General Psychiatry Open Access
REVIEW
How to improve adherence to antidepressant treatments in patients with major depression: a psychoeducational consensus checklist Bernardo Dell’Osso1,2,3,4*, Umberto Albert5,6, Giuseppe Carrà7 , Maurizio Pompili8, Maria Giulia Nanni9, Massimo Pasquini10, Nicola Poloni11, Andrea Raballo12,13, Fabio Sambataro14,15, Gianluca Serafini16,17,18, Caterina Viganò1,2 , Koen Demyttenaere19,20, Roger S. McIntyre21,22,23,24,25 and Andrea Fiorillo26
Abstract Studies conducted in primary care as well as in psychiatric settings show that more than half of patients suffering from major depressive disorder (MDD) have poor adherence to antidepressants. Patients prematurely discontinue antidepressant therapy for various reasons, including patient-related (e.g., misperceptions about antidepressants, sideeffects, and lack of tolerability), clinician-related (e.g., insufficient instruction received by clinicians about the medication, lack of shared decision-making, and follow-up care), as well as structural factors (e.g., access, cost, and stigma). The high rate of poor adherence to antidepressant treatments provides the impetus for identifying factors that are contributing to noncompliance in an individual patient, to implement a careful education about this phenomenon. As adherence to antidepressants is one of the major unmet needs in MDD treatment, being associated with negative outcomes, we sought to identify a series of priorities to be discussed with persons with MDD with the larger aim to improve treatment adherence. To do so, we analyzed a series of epidemiological findings and clinical reasons for this phenomenon, and then proceeded to define through a multi-step consensus a set of recommendations to be provided by psychiatrists and other practitioners at the time of the first (prescription) visit with patients. Herein, we report the results of this initiative. Keywords: Adherence, Antidepressants, Major depressive disorder, Consensus, Concordance Background Major Depressive Disorder (MDD) is a prevalent, recurring and disabling condition that poses major challenges in the treatment of affected patients. Among critical issues related to MDD treatment, patients’ poor adherence to antidepressant medications plays a crucial role in many cases of nonresponse, acute relapses, recurrences *Correspondence: [email protected] 1 Department of Biomedical and Clinical Sciences “Luigi Sacco”, University of Milan, Milan, Italy Full list of author information is available at the end of the article
in the long term, and increased morbidity, comorbidity, and mortality [1]. It has been shown that depressive symptoms in MDD and mood disorders, in general, account for the majority of time spent ill despite availability of effective treatments [2]. In particular, analyses of long-time persistence of depressive symptoms in MDD patients show that earlier ages of onset is associated with greater symptom persistence, particularly in the youngest subjects [3]. Moreover, many studies showed that
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