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11/21/2014

Medication Adherence In Patients with Depression

Depression is a mental disorder that has an unknown cause. There are many explanations for developing depression including genetic, biological, environmental, and psychological features. Signs and symptoms of depression vary from minimal to severe. Indication that someone may need medication to regulate his or her mood include the following symptoms: persistent sadness, hopelessness, fatigue, irritable mood, loss of interest, feelings of guilt, difficulty concentrating, insomnia, and suicidal thoughts.

There are a variety of classes of medications used for depression, but they all need to be given an adequate trial of about twelve weeks to see if the medication is efficacious. Roughly fifty percent of patients prematurely discontinue antidepressant therapy.  There are serious outcomes if medication is not taken including suicide. A systemic review by Chong evaluated the impact of education and behavioral interventions on antidepressant medication adherence and depression disease progression. This review showed patient education alone did not improve medication adherence rates; however, when used with behavioral changes and multifaceted interventions, adherence rates and depression outcomes improved. Behavioral and multifaceted interventions include education, telephone follow-up, medication support, and communication with primary care providers. For this reason, it is crucial to have pharmacist intervention when dealing with antidepressants to provide proper counseling on the medication to lead to better insight on the medication as well as intervene on proper behavioral changes.

Pharmacists can help increase outcomes of depressed patients by counseling them on their medication. Antidepressants are different than other medications because they need a longer period of time to feel it working. This presents as an issue for patients because they do not feel the need to take a medication that is not helping them feel better instantaneously. Also, patients might think they do not need a medication if they are starting to feel better.  Pharmacists should explain to the patient that it takes antidepressants at least two weeks to take effect. Patients should also be informed that there are common side effects associated with these medications and it is important to continue taking antidepressants for at least six to nine months to prevent reoccurrence of depression.

Because there are many negative side effects of depression, it is important to manage it with appropriate medications. Due to their expertise on antidepressants, pharmacists can counsel patients on what to expect, the onset of action, and duration of use for these medications. Through patient education, behavioral changes, and multifaceted interventions patients can have better outcomes for their depression.

Urvi Patel, PharmD 2016

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As you mentioned, depression medications typically have to be taken for at least 12 weeks before their efficiency and effectiveness can be determined. Should someone discontinue their medication before the end of the trial period, serious consequences can occur. I appreciate you pointing out the importance of fulfilling the trial period completely, which is important with any kind of pharmaceutical.

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