Enhancing Patient Outcomes: Treatment Adherence

Barriers to patient adherence to antidepressant therapy include lack of knowledge in several importantareas, including the nature of depression, the nature of treatments and how they can be expectedto work, and the efficacy of pretreatment education. Other obstacles include unpleasant sideeffects of medications and negative attitudes and beliefs about medication on the part of patients andtheir families and treating physicians. Such barriers can be surmounted by approaches based on principlesof good medical management, including: use of a multidisciplinary treatment team; educationof patients and their families regarding the nature of depression and its treatments; the formation of analliance among clinicians, patients, and family members; and the establishing of a clinic atmospherethat fosters such an alliance. Strategies to promote adherence should also address issues in practitionerdisposition and training and barriers that arise as a result of the direct effects of depressive illness onthe patient. In addition, such strategies must include measures appropriate to the different stages ofdepression treatment, including increased frequency of contact and intensity of support during acutetreatment, regular monitoring during ongoing treatment, and the establishment of long-term relationshipswith those patients who have a history suggesting vulnerability to relapse.