Thursday, October 18, 2018

Several Symptoms May Point to Suboptimal Medication Adherence in Patients With Depression

Despite the proven efficacy of antidepressants, a significant number of patients with depression fail to take these medications as prescribed, which can increase the risk of depression relapse, hospitalization, and more. A study in Depression & Anxiety now suggests that patients with major depression who have more severe symptoms, suicidal thoughts, and/or report physical pain may be most likely to report not taking their medications as prescribed.

Carolina Baeza-Velasco, Ph.D., of the University of Paris Descartes and colleagues examined data extracted from hospital admissions at the Department of Emergency Psychiatry and Acute Care of the University Hospital of Montpellier, France, between May 2012 and July 2015. A total of 360 adults aged 18 to 77 who met DSM-IV criteria for a current major depression episode and filled out the Medication Adherence Rating Scale (MARS) questionnaire were included in the study.

The MARS questionnaire asks patients to answer yes or no to 10 questions/statements on medication adherence behavior, beliefs/attitudes about taking medication, and side effects of medication. The researchers divided the study participants into two groups according to how they responded to the four MARS questions on medication adherence behavior—the “optimal adherence group” and the “suboptimal adherence group.” Patients in the optimal adherence group responded no to all four questions, including “Do you ever forget to take your medication?” and “When you feel better, do you sometimes stop taking your medication?”. Of the 360 patients included in the study, 107 (29.7%) were found to be optimally adherent to their medication.

The researchers next compared the responses of patients in the two groups to questions regarding depressive symptoms and suicidal thoughts; history of abuse and/or neglect during childhood; physical pain intensity; and psychiatric history. The number of psychiatric hospitalizations, the score of depression severity, suicidal ideation, reports of negative side effects from medication, and pain were significantly higher in the patients in the suboptimal adherence group compared with those in the optimal adherence group. Patients in the suboptimal adherence group also had less favorable attitudes toward medication and were less likely to be married/living with a partner than patients in the optimal adherence group.

“These results suggest a vicious circle in which more vulnerable patients are less adherent to medication, which could worsen the clinical picture maintaining, in turn, low adherence,” the researchers concluded.

For related information, see the Psychiatric News article “Motivational Pharmacotherapy Can Improve Medication Adherence,” by Roberto Lewis-Fern├índez, M.D., of Columbia College of Physicians and Surgeons.

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