Abstract
Purpose
Patient adherence to antidepressants is poor. However, this is rather unsurprising, given the equivocal efficacy, side effects, and practical problems of antidepressants. The aim of this study was to examine a wide array of patient experiences and perceptions regarding the efficacy, side effects, and practical problems of antidepressants, as well as their associations with nonadherence, and whether patients’ perceived self-efficacy moderated these associations.
Patients and methods
Experiences and perceptions of 225 patients, recruited through community pharmacies, were efficiently assessed with the Tailored Medicine Inventory. Nonadherence was assessed through self-report and pharmacy refill data.
Results
Many patients were not convinced of the efficacy, thought the efficacy to be limited or did not believe antidepressants to prevent relapse, were worried about or had experienced one or more side effects, and/or had experienced one or more practical problems regarding information, intake, and packaging. Being convinced of efficacy was associated with lower intentional nonadherence (odds ratio [OR] 0.9, 95% confidence interval [CI] 0.8–0.96). A higher number of practical problems experienced was associated with increased unintentional nonadherence (OR 1.3, 95% CI 1.1–1.7). Higher perceived self-efficacy regarding taking antidepressants was associated with lower unintentional nonadherence (OR 0.7, 95% CI 0.5–0.9). Perceived self-efficacy did not moderate associations of patient experiences and perceptions with nonadherence.
Conclusion
Assessing a wide array of patients’ experiences and perceptions regarding the efficacy, side effects, and practical problems of antidepressants contributes to better understanding of nonadherence to antidepressants. Guiding physician–patient conversations by patients’ experiences and perceptions may reduce both unintentional and intentional nonadherence. Also, it may give rise to considerations of prudent discontinuation, eg, when patients are not convinced of the efficacy.
Supplementary materials
Table S1 Items to assess experiences and perceptions with regard to the efficacy of antidepressants
Table S2 Items to assess unintentional and intentional nonadherence
Acknowledgments
We kindly thank all study participants for their participation. We kindly thank Ms Gemma Maatman, Ms Nina Winter, the community pharmacists, and the pharmacy interns for their assistance with regard to collecting the data. We kindly thank the volunteers for filling out the questionnaire. The work presented in this paper was financially supported by a grant from The Netherlands Organization for Health Research and Development (ZonMw) (grant 152002028).
Author contributions
All authors jointly developed the manuscript content and were involved in at least one of the following: conception, design, data acquisition, analysis, statistical analysis, interpretation of data, drafting the manuscript and/or revising the manuscript for important intellectual content. All authors provided final approval of the version to be published.
Disclosure
Dr Liset van Dijk has received two unrestricted grants from AstraZeneca and BMS. Dr Erica CG van Geffen is now employed at the Dutch Kidney Foundation (Nierstichting). The other authors report no conflicts of interest in this work.