When patients stop taking antidepressant drugs before the recommended treatment period is over, ineffective patient-physician communication may often be responsible, according to researchers.

National guidelines suggest that, in order to prevent relapse of depression, patients should stay on antidepressant drugs for at least 4 to 9 months after their symptoms of depression improve. However, many patients stop taking the antidepressant drugs within 3 months after beginning.

To investigate whether physician-patient communication might play a role in premature discontinuation of antidepressant treatment, Dr. Scott A. Bull of Kaiser Permanente in Oakland, California, and colleagues surveyed 137 prescribing physicians and 401 depressed patients treated with a selective serotonin reuptake inhibitor (SSRI). SSRIs include drugs such as Prozac and Zoloft.

Seventy-two percent of physicians reported that they told their patients that SSRIs must be taken for at least 6 months. However, only 34% of patients reported being told this and 56% said that they had received no instructions. Nine percent reported being told to take their medication for less than 6 months.

Compared with patients who reported being told to take their depression medication for at least 6 months, those who reported being told to take their medication for less than 6 months were more than three times as likely to discontinue therapy, according to the report published in September 2002 issue of The Journal of the American Medical Association.

Antidepressant treatment discontinuation was less likely when the adverse effects of the drug were discussed with the patient. However, switching medications was more common when the adverse effects were discussed, the authors note.

Other factors associated with antidepressant treatment discontinuation included fewer than three follow-up visits for depression, the occurrence of adverse effects, and lack of a response to the drug.

"After the acute recovery period, depression treatment guidelines recommend 4 to 9 months of therapy to prevent relapse of depression," according to Bull. "So we wanted to see how patient-physician communication influenced whether patients would continue therapy beyond the acute period."

Antidepressant compliance is similar to antibiotic compliance, Bull noted. "Patients often stop therapy once the symptoms have resolved," even though the disease is still present, he added.

"I don't think our findings are really very surprising," Bull said. "Patients who are given a clear indication of how long they should take a antidepressant drug are more likely to continue therapy than those not given this information," he added. "However, it is interesting that 72% of physicians said they told patients about treatment duration, but only 34% of patients said they had been told.

"I think the message is that physicians need to repeatedly tell patients what antidepressant treatment entails and not assume that they remember this information from their initial visit," Bull concluded.

SOURCE: The Journal of the American Medical Association 2002;288:1403-1409. (Sept. 2002)

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