An Epidemic of Patient Non-Compliance

Since the early '90's it's been thought that a majority of patients who are prescribed antidepressant medications fail to take them as directed. HEDIS data from that time suggested that only about 48% of patients prescribed medication were still taking it at six weeks, and only about 21% were still taking it at 12 weeks.

There is a widely held belief that there is better compliance with selective serotonin reuptake inhibitors (SSRIs) as compared with tricyclic antidepressants because of their faster onset of therapeutic action, greater efficacy, and better tolerance. To test that theory, researchers conducted a multi-center, randomized, parallel-group, open-label comparison of dothiepin (a Tricyclic) and fluoxetine (a SSRI) and compared compliance across the two groups.

As shown in the table below, seventy six percent of the fluoxetine patients (N=58) and 64% of dothiepin patients (N=49) were compliant with treatment at or above the 80% level over the 12-week study - a significantly greater degree of compliance for the SSRI group. These data represent a more precise estimate of compliance than do HEDIS data. They are suggestive of an overall higher level of antidepressant medication adherence than previously thought, with a compliance advantage for the SSRI's. 

However, to my eye, the more interesting aspect of this study is the finding that between one-quarter and one-third of patients who were prescribed antidepressant medication stop taking it during the first three months of treatment.

As Yogi Berra famously said, "If people are determined to stay away from the ballpark, you just can't make them." Twelve weeks or fewer is too short a time frame to treat depression effectively and prevent its recurrence.

Data such as these are particularly disappointing since it is well established that more than 80% of patients with depression can be treated effectively when there is treatment adherence.  Over 70% of prescriptions of antidepressant medications in the U.S. are written by primary care practitioners. And when treatment is consistent with best practice guidelines, that is good all the way around.

However, for the one-quarter to one-third of patients who don't comply with treatment recommendations, or for those patients who don't show a significant treatment response within six weeks, referral to a 1DocWay psychiatrist or psychologist can be essential to engaging patient compliance or modifying treatment strategy.

Contact us to learn more about how 1DocWay telepsychiatry and telepsychology can help improve patient compliance.