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Am Fam Physician. 2007;75(7):1069

Background: Nonadherence to antidepressant therapy is common, with more than two thirds of patients discontinuing treatment within three months of starting a medication. Studies have shown that providing patients with adequate information about their anti-depressants can improve adherence. Young and colleagues evaluated the type of information physicians provide when prescribing antidepressants to determine the relationship between the delivery of this information and disease severity.

The Study: Standardized patients (persons trained to portray roles consistent with major depression or adjustment disorder with depressed mood) presented unannounced to internal medicine and family physician practices. The office visits were audiotaped.

The information given by physicians when prescribing antidepressants was analyzed using a predefined coding system. Information identified by the coding system included the medication's purpose, name, cost, and dosing information. In addition, the analysis quantified the five following instructional messages to determine how often they were mentioned: (1) the need to take the medication every day, (2) the time needed to notice a benefit, (3) the importance of consulting a physician before discontinuing the medication, (4) the importance of continuing the medication even after symptoms improve, and (5) follow-up information.

Results: Data was obtained for 129 visits. Physicians provided information on an average of 5.7 out of 11 possible topics per visit. The most commonly mentioned topics were the antidepressant's purpose (96.1 percent), name (90.7 percent), adverse effects (85.3 percent), and timing/schedule (76.0 percent). The least common topics were barriers that might interfere with adherence (1.6 percent) and how to handle a missed dose (0.8 percent). Physicians provided an average of 1.7 out of five possible instructional messages per visit. The most commonly mentioned messages were lag time before a beneficial effect is noticeable (69.8 percent) and the importance of daily dosing (68.2 percent). More information was given to patients diagnosed with adjustment disorder with depressed mood than to those diagnosed with major depression.

Conclusion: The authors conclude that, although physicians commonly mention the medication's name, purpose, and adverse effects when prescribing an antidepressant, other important information is mentioned less often. Physicians also tend to provide more information to less severely depressed patients. The authors conclude that adherence to antidepressant medications might be improved by developing better patient education strategies, especially those focusing on anticipated duration of therapy and the need to wait several weeks before symptom improvement will be noticeable.

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