Introduction
The prevalence of depression in the United Kingdom is reported to be 10% of the population (Lecrubier and Hergueta 1998). Studies have investigated the diagnosis of depression and outcomes of therapy. In terms of medication it has been shown that compliance with antidepressant drug therapy is as low as 48-56% at the end of three months (Maddox et al. 1994; Lin et al. 1995). Although these quantitative studies have identified possible reasons for this, the issue has not been addressed in the context of patients' overall disease management. This research aims to enhance the understanding of patients' experiences of taking antidepressant medication and the factors which are important in decisions about treatment. Recently, there has been increasing emphasis on patients being involved in decisions about their therapy. It is essential that we obtain information about patients' concerns and needs in order to advance this process.

Methods
Preliminary fieldwork involved meeting with local self help groups of national organisations for people with depression. Exploratory discussions were carried out with the groups and individual patients were interviewed. An interview schedule consisting of mostly open questions was used.

Recruitment of patients beginning courses of antidepressants is currently being undertaken for the main study. The patients are being identified through GP practices. The methodology involves administration of a semi structured interview based on the combination of a qualitative interview and three quantitative validated instruments. The interview is being carried out on two occasions; one month and four months after the first prescription for therapy.

Results and Discussion
The presentation will report findings of the preliminary fieldwork and the development and first phase of the main study. The sample for the main study includes patients who were continuing with medication, patients who had discontinued and patients who had never commenced therapy. Results of the qualitative analysis will be reported. Factors which have been identified as being important for patients are beliefs about depression, beliefs about medicines, choice of agent and dosage, perceived risks and benefits, and the level of personal involvement that patients wish to have about decisions regarding their therapy. The last of these factors not only varies between patients but also at different points in time during treatment. Patients seemed more likely to relinquish control at the start of treatment, than when they had been taking their medication for a short while. The impact of these findings on the development of the research and their implication for antidepressant use in general practice will be discussed further.

References

1. Lecrubier, Y. and Hergueta, T. (1998) Differences between prescription and consumption of antidepressants and anxiolytics. International Clinical Psychopharmacology 13, S7-S11
2. Lin, E.H.B., Von Korff, M., Katon, W.J. Bush,T., Simon, G.E. and Robinson, P. (1995). The role of the primary care physician in patients' adherence to antidepressant therapy. Medical Care 33, 67 -74
3. Maddox, J.C., Levi, M. and Thompson, C. (1994). The compliance with antidepressants in general practice. Journal of Psychopharmacology 8, 48-53