Antidepressant-related adverse effects impacting treatment compliance: Results of a patient survey

Background: Despite the high prevalence of depression in the United States, few studies have identified which adverse effects (AEs) patients are willing or unwilling to tolerate when receiving antidepressants. Objective: The aim of this study was to identify reasons for discontinuation and noncompliance with antidepressant medications, the impact of AEs on compliance and quality of life (assessed using impact of AEs on activities of daily living), and patients' suggestions for improving their medication, using a patient survey. Methods: Patients aged 18 to 65 years with mild to severe depression were randomly selected by their physicians to be sent an invitation to complete the 42-question survey. Three hundred physicians nationwide assessed the severity of depression and symptoms of anxiety in each respondent, using their judgment. Patients were asked specific questions to assess reasons for discontinuation/noncompliance. Patients were also asked to rate AEs based on how difficult they were to "live with," and what 2 aspects of their antidepressant medication they would change if they could. Results: In a separate, concurrent study, physicians classified 175 (50%) as mildly to moderately depressed and 84 (24%) as severely depressed. Ninety-one respondents (26%) were classified as having symptoms of anxiety. Two hundred seven patients (60%) indicated they had discontinued treatment with an antidepressant agent at some point in their lives, the most common reason for which was lack of efficacy (92 patients [44%]). Of the 344 patients currently being treated with an antidepressant, 75 (22%) reported noncompliance. The most common reasons for noncompliance were "have trouble remembering to take it" (19/44 patients [43%]), "gained a lot of weight" (11/41 [27%]), "unable to have an orgasm" (8/40 [20%]), and "lost interest in sex" (8/41 [20%]). The 4 AEs patients expressed as "extremely difficult to live with" were "weight gain" (104 patients [31%]), "unable to have erection" (83 [25%]), "difficulty reaching orgasm" (80 [24%]), and "tired during the day/no energy" (69 patients [21%]). The 3 most frequently cited improvements patients (n = 327) would make to their medications were better efficacy (176 patients [54%]) and eliminating AEs related to sexual desire and weight gain (112 [34%] and 105 [32%] patients, respectively). Conclusions: The findings of this survey of patients with mild to severe depression suggest that compliance, and hence efficacy, can be promoted by (1) understanding what patients expect and desire from the antidepressants they are prescribed and (2) prescribing antidepressants associated with low rates of weight gain, sexual dysfunction, or tiredness. Copyright © 2005 Excerpta Medica, Inc.