title: Primary-care patients' trade-off preferences with regard to antidepressants.
abstract: BACKGROUND
  Antidepressants are frequently prescribed but results regarding their efficacy have been equivocal for different spectra of the severity continuum and their side-effects are often burdensome. Non-adherence is a likely consequence. The objective was therefore to examine patients' trade-offs between the efficacy, side-effects and other drawbacks of antidepressants and whether these trade-offs predicted non-adherence.
  
  
  METHODS
  Trade-offs from 225 antidepressant users, recruited through community pharmacies, were assessed with an Adaptive Conjoint Analysis (ACA) choice task that was customized to each individual patient. From the estimated utilities, relative importance scores of treatment properties were calculated. Non-adherence was measured through self-report and pharmacy refill data.
  
  
  RESULTS
  Relapse prevention and symptom relief were on average equally important. Side-effects were as important and the side-effect stomach and intestine complaints was on average even slightly more important than relapse prevention and symptom relief. Additional treatment with psychotherapy was preferred by 61% of the patients. A benefit/drawback ratio revealed that 18% of the patients did not consider the efficacy to outweigh the drawbacks. A higher benefit/drawback ratio was associated with a decreased odds of intentional non-adherence [odds ratio (OR) 0.2, 95% confidence interval (CI) 0.07-0.7, Wald = 6.7, p = 0.01).
  
  
  CONCLUSIONS
  For nearly one in five patients, the efficacy of antidepressants does not outweigh their drawbacks. Knowing patients' trade-offs is likely to aid both physicians and patients to identify important treatment preferences, to improve adherence and to make more deliberate decisions on whether or not to continue treatment.
authors.affiliation: Division of Pharmaco-epidemiology and Clinical Pharmacology, Faculty of Science,Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University,Utrecht,The Netherlands.
authors.forename: H
authors.initials: H
authors.lastname: Wouters
authors.affiliation: NIVEL, Netherlands Institute for Health Services Research,Utrecht,The Netherlands.
authors.forename: L
authors.initials: L
authors.lastname: Van Dijk
authors.affiliation: Division of Pharmaco-epidemiology and Clinical Pharmacology, Faculty of Science,Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University,Utrecht,The Netherlands.
authors.forename: E C G
authors.initials: EC
authors.lastname: Van Geffen
authors.affiliation: Division of Pharmaco-epidemiology and Clinical Pharmacology, Faculty of Science,Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University,Utrecht,The Netherlands.
authors.forename: H
authors.initials: H
authors.lastname: Gardarsdottir
authors.affiliation: Department of Medical Decision Making,Leiden University Medical Centre,Leiden,The Netherlands.
authors.forename: A M
authors.initials: AM
authors.lastname: Stiggelbout
authors.affiliation: Division of Pharmaco-epidemiology and Clinical Pharmacology, Faculty of Science,Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University,Utrecht,The Netherlands.
authors.forename: M L
authors.initials: ML
authors.lastname: Bouvy
mesh_terms: D000328:Adult; D000368:Aged; D000928:Antidepressive Agents / Q000009:adverse effects / Q000627:therapeutic use*; D003866:Depressive Disorder / Q000188:drug therapy / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D057240:Patient Preference / Q000706:statistics & numerical data*; D011320:Primary Health Care / Q000706:statistics & numerical data*; D016903:Drug Monitoring
chemical_list: D000928:Antidepressive Agents