Antidepressant Medical Management

06/30/2023

Major Depression is one of the most common mental illnesses affecting more than 21 million American adults each year. ¹ Approximately 60% of those treated for depression are cared for by Primary Care Physicians (PCPs) and almost 80% of antidepressants are prescribed by non-mental health professionals. ²

Studies conducted in primary care and psychiatric settings show that more than half of patients suffering with Major Depression have poor adherence. Patient-related reasons for discontinuation may include stigma, lack of understanding how the drug works, worries about side effects, or cost. Clinician-related reasons for poor adherence can include lack of shared decision-making with the patient, insufficient education about how the medication works or side effects, or lack of follow-up. ³

A checklist can be a valuable tool to help practitioners improve adherence with an additional emphasis on patient education about the importance of medication adherence, opportunities for shared decision-making, and the importance of follow-up appointments. ⁴

Checklist to improve patient education and shared decision-making:

Confirm the diagnosis and explain to the patient that it is a biological and treatable disorder. Include examples of symptomology the patient reported.
Discuss any recommendation for pharmacological treatment based on the severity of symptoms, previous depressive episodes, current situation etc. Discuss patient expectations for medication.
Include the patient in the selection of an antidepressant and explain why one may be more effective than another based on age, gender, previous experiences, medical and psychiatric comorbidities.

Once a medication is chosen, explain to the patient:

How the medication works, its advantages, and how to use it safely
It may take three to four weeks for the medication to have a noticeable impact on mood
How long treatment will last
Potential side effects, how long they usually last, and when to reach out with concerns
Dosage, scheduling and compliance recommendations
Lifestyle changes that need to be made such as avoiding caffeine and alcohol or increasing physical activity.