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Am Fam Physician. 2007;75(6):912-915

Background: Approximately one out of five persons will have a major depressive disorder during his or her lifetime. Many classes of medications have been shown to be effective in treating this disorder, but studies suggest that it can take two to six months of treatment for maximal benefit. However, a significant number of patients stop taking their medications before this, which is associated with a greater risk of relapse.

Selective serotonin reuptake inhibitors have improved tolerability and a lower discontinuation rate compared with older antidepressants, but patient discontinuation still can be as high as 28 percent within the first three months. Additionally, only 30 percent of patients discuss stopping their antidepressant medications with their physicians, and 25 percent stop their medications but tell their physicians they are continuing to take them. Reasons for discontinuation are multifactorial and need to be addressed. Providing patient education to improve compliance with a patient's other treatment regimens is one such strategy. Bron and colleagues assessed a patient education intervention designed to improve compliance with treatment.

The Study: Patients 18 to 65 years of age who were taking sertraline (Zoloft) and enrolled in the patient education program for one year were included in the study. Knowing More, an educational program that provides patients with information about sertraline, primarily targets patients who have taken the medication for fewer than three months. Persons who were started on the same medication but not enrolled in the patient education program made up the control group and were matched for age, gender, start time, and various components of sertraline use.

The intervention consisted of 10 patient communications over nine months that were mailed and sent by e-mail. After treatment initiation, follow-up was conducted for seven months. Using time to discontinuation and days of therapy, patients in the Knowing More program and those in the control group were assessed for adherence to their treatment regimens.

Results: The study population included 1,462 patients in the intervention group and the matching control group. The time to discontinuation was greater in the patient education group compared with the control group. At the end of the study, a significantly greater number of patients in the education group continued to take their medication. The mean number of days on therapy was 122.5 for the intervention group compared with 97.7 for the control group.

Conclusion: This study demonstrates that early patient education intervention can improve patient compliance with antidepressant therapy, and that intervention can be performed by mail.

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Copyright © 2007 by the American Academy of Family Physicians.

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