Consumer-related factors influencing antidepressant adherence in unipolar depression: a qualitative study

Figures & data

Table 1 Characteristics of the participants (n=23)

Characteristics	N
Demographic data
Age range (years): 19–63, median: 37, mean: 40
Gender: females/males	15/8
Self-report ethnic group
– Oceania (Australia or New Zealand)	16
– Others (Americas, South-East Asia, North-West Europe, South African, Southern and Eastern Europe)	7
Living circumstances
– Living with partner or family	10
– Living with roommate/housemate	5
– Living alone	8
Highest level of education completed
– Secondary	6
– Diploma	3
– Bachelor	9
– Postgraduate	3
– Other*	2
Prescription of antidepressant: <5/≥5 years	13/10
Current antidepressant medicines prescribed
SSRIs: citalopram, escitalopram, fluoxetine, paroxetine, sertraline	9
SNRIs: desvenlafaxine, duloxetine, venlafaxine	7
TCA: amitriptyline	1
Others: mirtazapine, phenelzine, reboxetine	3
Most recently ceased antidepressant medicines prescribed
SSRIs: escitalopram, sertraline	3

Note:

* Primary school, certificate.

Abbreviations: SSRI, selective serotonin reuptake inhibitors; SNRI, serotonin-norepinephrine reuptake inhibitors; TCA, tricyclic antidepressants.

Figure 1 Factors which positively influenced medication adherence at the three phases of adherence: initiation, implementation, and discontinuation of therapy.

Abbreviation: ADRs, adverse drug reactions.

Table 2 Indicative quotes of positive and negative factors influencing the three phases of adherence

Factors	Themes	Quotes
Positive	Self-motivation	1. [I wanted] to lessen some of the symptoms that I had […] I was down, really down and upset [No 9/M/30 Y; Adherence phase: I/P/D]
		2. I’ll just keep going down and down and down until I feel I’ve got to get back up again. I’ll start that [antidepressant] again. [No 5/F/57 Y; Adherence phase: I/P/D]
	Fear of negative consequences of ceased antidepressant medicines	3. It took nearly a week [for them] to work and since then I’ve had a fear of stopping them so I’ve never really done it because I am too scared to stop and get those feelings back. [No 20/F/53 Y; Adherence phase: P/D]
	Belief in and the effectiveness of antidepressant medicines	4. I’m a little bit doubtful, but, […] I’ve seen medication [used] in family and friends, and I’ve seen it work. [No 15/M/44 Y; Adherence phase: I/P/D]
Negative	Fear of anticipated ADRs	5. I was really worried about weight gain and I didn’t want to take medication that would make me gain weight. [No 22/F/28 Y; Adherence phase: I]
	Self-stigma	6. I really didn’t want to [take them] in the beginning. I think it’s just […] embarrassing […] I felt like there’s something wrong with me […] [but] I could just talk myself into being happy instead of having to take it. [No 22/F/28 Y; Adherence phase: I/P/D]
	Experiencing unpleasant ADRs	7. The Avanza^® [mirtazapine], it was prescribed to me, I was in a pretty difficult position and with Avanza it helps you sleep but I didn’t like it because I stacked on the weight [No 21/M/45 Y; Adherence phase: I/P/D]
	Economic issue	8. The newest one that I tried which I went off was Valdoxan^® [agomelatine] because it
		was so expensive [No 5/F/57 Y; Adherence phase: P]
	Forgetfulness	9. First thing I’ll do is just put that [antidepressant] in my hand and take it. I made the mistake of putting my tablet two days ago into my dressing gown pocket, and that’s where it stayed. I found it the next day. Forgetfulness is also a symptom of depression and I find that I do suffer [No 19/F/60 Y; Adherence phase: P]
	Previous negative experiences of antidepressant medicines	10. When I read the symptoms or side effects of it, I thought, yeah, I’ve had this before. I’m not going on it. [No 18/M/28 Y; Adherence phase: D]

Abbreviations: M, male; F, female; Y, years old; I, initiation; P, implementation; D, discontinuation.

Figure 2 Factors which negatively influence medication adherence at the three phases of adherence: initiation, implementation, and discontinuation of therapy.

Abbreviation: ADRs, adverse drug reactions.

Table S1 Index of the terms used in this study, in relation to influencing factors

Influencing factors	Definition in the study
Positive factors
Education about antidepressant treatment	Patient’s knowledge about the use of antidepressant medicines in depression treatment, including health literacy.
Willingness to follow doctor’s order	Willingness and ability to follow doctor’s order pertaining to the use of antidepressant medicines in treatment of depression.
Acceptance of depression diagnosis	Acceptance that one has a diagnosis of depression.
Recognition of antidepressant medicine	The recognition of the importance of antidepressant medicines in the treatment of unipolar depression.
Positive effects of antidepressant treatment	Experiencing or beliefs about experiencing positive effects form the use of antidepressant medicines, such as, the effectiveness of antidepressant, clinical improvement, recovery, feeling better, few or no ADRs, and the observation of positive treatment outcomes from family members and/or friends.
Self-motivation	The reliance on one’s own powers and resources rather than those of others. This includes a desire to feel better and achieve better clinical outcomes as well as self-reliance.
Self-management	The management of oneself pertaining to the consumption of antidepressant medicines; the taking of responsibility for regular consumption. This includes routines for taking antidepressant medicines, use of reminders or alarms, pill box, Webster-pak^®, diary etc.
Negative factors
Unwillingness to rely on medicine	The reluctance to use antidepressant medicines.
Denial of depression diagnosis	Belief that one does not have depression.
Denial of the need for antidepressant treatment	Belief that one does not need an antidepressant medicine for treatment of depression.
Disorganized life	Relevant factors pertaining to everyday living that negatively influence medication adherence such as running out of antidepressant medicine, excessive alcohol consumption, illicit substance use, etc.
Concern about long-term antidepressant treatment	Negative thoughts and concerns about long-term use of antidepressant medicines including fear of addiction, interference with natural functions of the brain or body, etc.
Self-stigma	The process of an individual accepting society’s negative evaluation and incorporating it into his or her own personal value system and sense of self.^Citation1
Negative effects of antidepressant therapy	Experience or beliefs about experiencing negative effects from the use of antidepressant medicines; including ineffective antidepressant treatment, feeling worse, unsatisfactory treatment outcome, the existence of depressive symptoms, etc.
Trial cessation of antidepressant	Personal experiment to cease antidepressant medicine without the guidance of health practitioners.

Abbreviation: ADR, adverse drug reaction.

LivingstonJDBoydJECorrelates and consequences of internalized stigma for people living with mental illness: a systematic review and meta-analysisSoc Sci Med201071122150216121051128

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