Antidepressant Use Prolonged With Doctor-Patient Talks

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Doctor-Patient Dialogue
Combats Depression

Those who confer regularly with physicians more likely to stay on antidepressant drugs they need

Sept. 18, 2002 (HealthScoutNews) -- Depressed people who talk frequently with their doctors about the depression medications they are taking are more likely to stay on those antidepressant drugs long enough for them to help.

"This is nothing too scientific or technical," says Scott Bull, lead author of a Kaiser Permanente study that appears in today's issue of the depressed people who talk with their doctors frequently are more likely to stay on antidepressants that help them. Journal of the American Medical Association. "The simple fact is that communication seems to improve adherence to treatment plans."

This would seem to be the case with health issues beyond psychiatry.

"Over the years, studies have looked at what patients remember from their visits with doctors and, in general, patients remember maybe 50 percent of what their doctor says," says Dr. Milton W. Anderson, head of child and adolescent psychiatry at the Ochsner Clinic Foundation in New Orleans.

"People can speculate about the reasons but, as I perceive it, unless they're very medically sophisticated, it's like drinking from a fire hydrant, especially in the modern health-care setting where time is often limited," Anderson says. "It's a tremendous art for a primary-care physician to come across as non-hurried and to give information in a concise manner."

According to the study authors, up to 68 percent of patients discontinue taking antidepressants within three months of starting, even though current guidelines recommend that antidepressant treatment needs to continue for at least four to nine months to prevent a relapse for depression.

Over the course of about 18 months, Bull and his colleagues conducted 401 telephone interviews with patients being treated with SSRIs (selective serotonin reuptake inhibitors such as Prozac), and also analyzed written surveys from 13 prescribing physicians.

The researchers found significant discrepancies between what doctors said they told patients and what patients remember being told regarding adverse effects and duration of treatment. Patients with three or more follow-up visits were more likely to continue for the prescribed length of time.

The most surprising finding, Bull says, was that 72 percent of doctors said they told patients up front that they would probably need to take the medication for at least six months, while only 34 percent of patients remembered being told this. More than half (56 percent) of patients said they received no instructions.

There may be several explanations for this discrepancy. "I think depression in itself probably makes it more difficult for patients to get out of bed and get into an office for follow-up," Bull says.

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People who are depressed also often have lapses in concentration and memory. Anderson points out that parents who are seeking help for their depressed children do not have problems with memory, motivation and concentration, and often have a very good follow-through record.

One issue that was not addressed was the length of the visits. The authors also did not discuss the value of giving out printed educational material, which, Anderson says, can be "quite helpful."

Whether it be printed material or verbal instructions, what's important, Bull says, is that "the message has to be reinforced throughout the course of care. If it's brought up only in the beginning of treatment, patients are probably going to forget."

As always, though, "communication is a two-way street," Bulls says.

What To Do

Are you concerned that you might be depressed? Find out by taking this online screening test from New York University School of Medicine.

Doctor-Patient Dialogue Combats Depression

Those who confer regularly with physicians more likely to stay on antidepressant drugs they need

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Doctor-Patient Dialogue
Combats Depression