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Understanding Medication Discontinuation in Depression

(PSYCHIATRIC TIMES) - Compared with schizophrenia, adherence behavior has been relatively overlooked in depression and other mood disorders.1-3 Major depression is increasingly thought of as a chronic illness.4 In most chronic illnesses, ideal concordance is the exception, not the rule. Barber and colleagues5 found that only 16% of patients taking medication for stroke, coronary heart disease, asthma, diabetes mellitus, and rheumatoid arthritis were adherent, problem-free, and in receipt of sufficient information when examined at 10 days. Should we expect our patients with mental health problems to be more or less able to adhere to our recommendations? Furthermore, are we more or less willing than our colleagues in other medical specialties to take the time to promote problem-free adherence in our patients?

Three new studies suggest that physicians should be vigilant for adherence difficulties in patients with depression (Table 1). In the Medical Expenditure Panel Survey, Olfson and colleagues6 looked at 829 people who had started antidepressant treatment for depression. Their findings showed that 42% discontinued antidepressants during the first 30 days and 72% had stopped within 90 days. Bambauer and colleagues7 documented partial nonadherence in 75% of individuals who were depressed, culminating in an average of 40% of days without taking dispensed antidepressants.

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