The World Health Organisation is predicting that depressive disorder will be the highest cause of disease in the developed region by 2020¹. Studies have shown that compliance with antidepressant medication is approximately 50% after three months of therapy^2,3, whereas it is recommended that medication is taken for at least 4 to 6 months⁴. This paper aims to present an in depth view of patients' decision making regarding medication at the beginning of treatment in primary care.

Patients beginning courses of antidepressant medication were identified through GP surgeries. A semi-structured interview, based on the combination of a qualitative interview and three quantitative instruments, was administered on 2 occasions after commencement of therapy. The qualitative part of the interview was audiotaped, transcribed verbatim and coded. With regards to the quantitative data, bivariate analysis was carried out to identify factors which distinguished between those who continued with their mediation and those who discontinued.

Out of 171 eligible patients who were invited to participate, 51 completed a first interview and 41 of these subsequently completed a follow up interview. Respondents had a wide range of socio- economic characteristics and had been prescribed different types of antidepressant medication. Analysis of interview data demonstrated that decision making about taking antidepressant medication was a complex process. Few factors distinguished between those who continued with their medication and those who discontinued. Respondents assessed their circumstances at a particular point in time and made a decision as to whether or not it would be beneficial to take medication.

This complexity in decision making was influenced by the paradoxical role of medication in affecting the return of normal life and functioning. On the one hand medication enabled patients to return to normality by controlling symptoms. However, on the other hand it also had a stigma attached which reduced interviewees sense of being normal. In addition, for some respondents adverse drug reactions reduced ability to perform their social roles.

Decisions about taking antidepressant medication were not made in isolation from other treatment strategies. Twenty three respondents reported taking herbal or homeopathic medication and 31 respondents had had some form of professional talk therapy. In addition, interviewees reported using a number of self coping strategies as part of their treatment, such as taking up more exercise or going to creative classes.

The findings thus inform understanding of patients' perspectives of antidepressant medication in the context of overall disease management.

References

1. The World Health Report 2001 World Health Organisation. Geneva.
2. Lin, E.H.B., Von Korff, M., Katon, W.J et al (1995).Medical Care 33, 67 -74
3. Maddox, J.C., Levi, M. and Thompson, C. (1994). Journal of Psychopharmacology 8,48-53
4. Paykel, E.S., Priest, R.G. (1992) BMJ, 305, 1198 - 1202

Acknowledgements

With thanks to the School of Pharmacy and the Royal Pharmaceutical Society of Great Britain's Galen Award and Sir Hugh Linstead Fellowship for funding this research.