title: Hospital patients' perceptions during treatment and early discontinuation of serotonin selective reuptake inhibitor antidepressants.
abstract: Studies have suggested that discontinuation of treatment in depressed patients is associated with their perceptions about their treatment. We surveyed 403 adults treated for major depressive disorder with a selective serotonin reuptake inhibitor (SSRI) 3 months after onset of treatment to assess their interactions with clinicians, reasons they stopped SSRI treatment, and SSRI side effects (SEs). Bothersome SEs, poorer instruction by physicians about SSRI SEs, and self-reported change in depression, sex, marital status, and employment were significantly (P < 0.05) associated with discontinuation. Logistic regression examined the associations between patients' perceptions during treatment planning and SSRI discontinuation. Seventeen percent of patients felt uninvolved in treatment decisions, 9% disagreed with the diagnosis, and 24% subsequently stopped treatment. Elevated risk of discontinuation was found among patients who felt uninvolved in treatment decisions (unadjusted risk ratio [RR], 2.3; 95% confidence interval [CI], 1.2-4.3) and those who disagreed with the diagnosis (RR, 2.0; CI, 0.9-4.4). Patients who both felt uninvolved and disagreed with the diagnosis were 7-fold as likely to discontinue their SSRI (RR, 7.3; CI, 1.5-36.3) compared with those who felt neither uninvolved nor disagreed. Selective serotonin reuptake inhibitor SEs, specific interactions with clinicians, self-assessed outcomes, and sociodemographics did not explain these associations. To improve adherence to medications, clinicians should consider patients' perceptions about their involvement in treatment decisions and agreement with their diagnosis.
authors.affiliation: Burlingame Center for Psychiatric Research and Education, The Institute of Living/Hartford Hospital, 200 Retreat Ave, Hartford, CT 06106, USA. swoolle@harthosp.org
authors.forename: Stephen B
authors.initials: SB
authors.lastname: Woolley
authors.forename: Lisa
authors.initials: L
authors.lastname: Fredman
authors.forename: John W
authors.initials: JW
authors.lastname: Goethe
authors.forename: Alisa K
authors.initials: AK
authors.lastname: Lincoln
authors.forename: Timothy
authors.initials: T
authors.lastname: Heeren
mesh_terms: D000328:Adult; D000928:Antidepressive Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D001294:Attitude to Health; D003625:Data Collection; D003865:Major Depressive Disorder / Q000188:drug therapy*; D005260:Female; D006760:Hospitalization; D006801:Humans; D016015:Logistic Models; D008297:Male; D055118:Medication Adherence / Q000523:psychology*; D008875:Middle Aged; D010358:Patient Participation / Q000523:psychology; D018802:Patient-Centered Care / Q000379:methods; D017367:Selective Serotonin Reuptake Inhibitors / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*
chemical_list: D000928:Antidepressive Agents; D017367:Selective Serotonin Reuptake Inhibitors