Abstract
AbstractBackgroundDespite their documented efficacy, substantial proportions of patients discontinue antidepressant medication (ADM) without a doctor's recommendation. The current report integrates data on patient-reported reasons into an investigation of patterns and predictors of ADM discontinuation.MethodsFace-to-face interviews with community samples from 13 countries (n = 30 697) in the World Mental Health (WMH) Surveys included n = 1890 respondents who used ADMs within the past 12 months.Results10.9% of 12-month ADM users reported discontinuation-based on recommendation of the prescriber while 15.7% discontinued in the absence of prescriber recommendation. The main patient-reported reason for discontinuation was feeling better (46.6%), which was reported by a higher proportion of patients who discontinued within the first 2 weeks of treatment than later. Perceived ineffectiveness (18.5%), predisposing factors (e.g. fear of dependence) (20.0%), and enabling factors (e.g. inability to afford treatment cost) (5.0%) were much less commonly reported reasons. Discontinuation in the absence of prescriber recommendation was associated with low country income level, being employed, and having above average personal income. Age, prior history of psychotropic medication use, and being prescribed treatment from a psychiatrist rather than from a general medical practitioner, in comparison, were associated with a lower probability of this type of discontinuation. However, these predictors varied substantially depending on patient-reported reasons for discontinuation.ConclusionDropping out early is not necessarily negative with almost half of individuals noting they felt better. The study underscores the diverse reasons given for dropping out and the need to evaluate how and whether dropping out influences short- or long-term functioning.
Funder
National Institute on Drug Abuse
U.S. Public Health Service
National Institute of Mental Health
Generalitat de Catalunya
Fogarty International Center
European Commission
Regione Piemonte
Robert Wood Johnson Foundation
Instituto de Salud Carlos III
Ministerio de Ciencia y Tecnología
GlaxoSmithKline
Pan American Health Organization
Bristol-Myers Squibb
Ministerio de Salud y Protección Social
Consejería de Sanidad y Política Social, Comunidad Autónoma de la Región de Murcia
Fundación para la Formación e Investigación Sanitarias de la Región de Murcia
Substance Abuse and Mental Health Services Administration
Ministerio de Salud de la Nación
Fundação Champalimaud
Servicio Murciano de Salud
Publisher
Cambridge University Press (CUP)
Subject
Psychiatry and Mental health,Applied Psychology