Older patients' aversion to antidepressants. A qualitative study.
BACKGROUND
Depression is common among older patients yet is often inadequately treated. Patient beliefs about antidepressants are known to affect treatment initiation and adherence, but are often not expressed in clinical settings.


OBJECTIVE
To explore attitudes toward antidepressants in a sample of depressed, community-dwelling elders who were offered treatment. DESIGN. Cross-sectional, qualitative study utilizing semi-structured interviews.


METHODS
Primary care patients age 60 years and over with depression, from academic and community primary care practices of the University of Pennsylvania Health System and the Philadelphia Department of Veterans Affairs. Patients participated in either the Prevention of Suicide in Primary Care Elderly: Collaborative Trial or the Primary Care Research in Substance Abuse and Mental Health for the Elderly Trial. Sixty-eight patients were interviewed and responses from 42 participants with negative attitudes toward medication for depression were analyzed.


METHODS
Interviews were audiotaped, transcribed, and entered into a qualitative software program for coding and analysis. A multidisciplinary team of investigators coded the transcripts and identified key features of narratives expressing aversion to antidepressants.


RESULTS
Four themes characterized resistance to antidepressants: (1) fear of dependence; (2) resistance to viewing depressive symptoms as a medical illness; (3) concern that antidepressants will prevent natural sadness; (4) prior negative experiences with medications for depression.


CONCLUSIONS
Many elders resisted the use of antidepressants. Patients expressed concerns that seem to reflect their concept of depression as well as their specific concerns regarding antidepressants. These findings may enhance patient-provider communication about depression treatment in elders.
Givens
Jane L
JL
Division of General Internal Medicine, University of Pennsylvania, Philadelphia, PA, USA. jagivens@mail.med.upenn.edu
Datto
Catherine J
CJ
Ruckdeschel
Katy
K
Knott
Kathryn
K
Zubritsky
Cynthia
C
Oslin
David W
DW
Nyshadham
Soumya
S
Vanguri
Poornima
P
Barg
Frances K
FK
D000368:Aged; D000369:Aged, 80 and over; D000375:Aging / Q000523:psychology*; D000928:Antidepressive Agents / Q000009:adverse effects / Q000627:therapeutic use*; D001294:Attitude to Health; D003430:Cross-Sectional Studies; D003863:Depression / Q000188:drug therapy* / Q000523:psychology*; D005239:Fear; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D010342:Patient Acceptance of Health Care; D010361:Patients / Q000523:psychology*; D019966:Substance-Related Disorders / Q000209:etiology
D000928:Antidepressive Agents