Patient-Centered Perspectives on Antidepressant Use

Abstract

High rates of antidepressant prescribing in Western countries have coincided with increasing doubts about the effectiveness of these medications, especially for the treatment of mild to moderate depression in primary care. This narrative review constructs a patient-centered perspective on antidepressant use, which examines research on patients' attitudes to antidepressants and their treatment preferences; experiences of being prescribed antidepressants and taking antidepressants, as well as reasons for adherence or nonadherence. Key themes in the research literature suggest that patients have predominantly negative views of antidepressants and that they prefer psychotherapy to medication. Patients may agree to antidepressants because they have limited information about the medication or about other treatment options. Although they may see themselves as active in the decision to take antidepressants, they tend to accept the physicians' recommendation during the initial crisis period during which they seek help. They may also continue taking antidepressants because of experience of withdrawal symptoms and lack of on-going support from their physician. Patients may be acting on rational concerns about an antidepressant when they choose not to comply with its prescription. This review suggests that physicians should be more active in discussing patients' concerns about antidepressants with them.