Matthew S. Keene, MD
Depression is among the most common psychiatric disorders in the United States, with lifetime prevalence rates in excess of 17%. It is not surprising, then, that depression places a substantial economic burden on the US healthcare system, and current costs exceed $81 billion per year. Worldwide, the economic toll of depression is far greater. By the year 2020, the World Health Organization projects depression to be the second leading cause of global disease burden.
One of the best ways for clinicians to reduce this staggering disease burden is to simply treat depressed patients correctly, for a long enough period of time. Data support the findings that antidepressant responders who remain on their antidepressants for up to 36 months have relapse rates of only 18%, whereas those who are switched to placebo have relapse rates that exceed 40%. Indeed, long-term antidepressant treatment works, but, unfortunately, patients often don't "sign up" for such long-term approaches.
Compliance with antidepressant treatment is abysmally low. In 1995, Lin and colleagues demonstrated that 28% of patients discontinued their antidepressants within the first month, often before the drug had much chance to work. Given that over half of the patients Lin followed were on tricyclic antidepressants (TCAs), one would now anticipate that since prescribing patterns have shifted to better-tolerated antidepressants (selective serotonin reuptake inhibitors [SSRIs], bupropion, etc.), compliance would have improved over the last few years. However, that doesn't seem to be the case.
In recently analyzed adherence data from over 740,000 newly initiated immediate-release SSRI patients, Eaddy and associates found that nearly 50% of patients failed to adhere to therapy for a minimum of 60 days, and only 28% were compliant at 6 months.
Why do patients prematurely discontinue antidepressants, medications that may improve and perhaps even save their lives? The reasons vary but typically distill down to one of the 3 Cs of noncompliance: confusion, costs, and complaints. Let's take a closer look at these critical factors.
"I took that medication for 3 days and didn't feel anything."
"I felt better so I didn't need it anymore."
"I don't want to get addicted." Whether it is unrealistic patient expectations for immediate results or blatant Hollywood hype, misperceptions and misinformation surrounding antidepressant treatment prevail, undeniably impeding compliance.
To compound matters, depression frequently impairs cognition, contributing to patient-physician misunderstanding. When Bull and colleagues surveyed 137 prescribing physicians and 401 depressed patients, they found that even though 72% of the physicians reported that they had told their patients to take their antidepressants for at least 6 months, only 34% of these patients recalled being told this; 56% reported receiving no instruction at all.
Perhaps the simplest way to overcome confusion is with continued patient education. In Bull's analysis, patients who recalled receiving instructions were two thirds less likely to discontinue therapy early compared with patients who were not told or did not recall being told. Likewise, Katon and colleagues demonstrated significantly improved adherence to antidepressant medications in a subset of 386 primary care patients who received educational "intervention" (self-study book, videotape, visits with a depression specialist, etc.) compared with the "usual care" subset.
One additional comment stemming from confusion is, "I can't remember the second dose." Dosing frequency impacts compliance. Taking a medication 2, 3, or 4 times a day is progressively more difficult than taking a medication once daily or even once weekly. To this end, delayed-release technology that decreases the frequency of dosing, has been shown to enhance antidepressant compliance.
For example, Claxton and colleagues evaluated compliance in patients who initially received fluoxetine 20 mg daily for 1 month (Period 1) and then either were continued on fluoxetine 20 mg daily or switched to a 90-mg once-weekly version of fluoxetine for a subsequent 3 months (Period 2). By the end of Period 2, compliance had statistically worsened in the once-daily arm of the study but was either the same or improved in the once-weekly arm.
Similarly, a database review of more than 85,000 patients showed that those taking once-daily bupropion XL were 65% more likely to meet a 3-month adherence threshold than patients taking twice-daily bupropion SR.
IN THE WORKPLACE
Research on Depression in the Workplace.
For more information please click here
Mental Health Matters Journal for Psychiatrists & GP's
Click here for more info
If you are a journalist writing a story contact Kayla on 011 234 4837 firstname.lastname@example.org
It’s the small things that make a BIG difference. Sign up for the “My School | My Village | My Planet” Card and start making a difference to Mental Health in South Africa today.
Literacy is a luxury that many of us take for granted. That is why SADAG created SPEAKING BOOKS and revolutionized the way healthcare information is delivered to low literacy communities.
The customizable 16-page book, read by local celebrity audio recordings, ensures that vital health and social messages can be seen, heard, read and understood by everyone across the world.
We started with books on Teen Suicide prevention , HIV, AIDS and Depression, Understanding Mental Health and have developed over 100+ titles, such as TB, Malaria, Polio, Vaccines for over 45 countries.
- Click here to see speaking books in action
- Click here for sample book on clinical trials
- Click here to connect to international site
- Speaking books for Health Care YouTube
Matthew S. Keene, MD
Dr Reddy's Help Line
0800 21 22 23
Cipla 24hr Mental Health Helpline
0800 456 789
Pharmadynamics Police &Trauma Line
0800 20 50 26
Adcock Ingram Depression and Anxiety Helpline
0800 70 80 90
0800 55 44 33
Department of Social Development Substance Abuse Line 24hr helpline
0800 12 13 14
Suicide Crisis Line
0800 567 567
SADAG Mental Health Line
011 234 4837
Akeso Psychiatric Response Unit 24 Hour
0861 435 787
Cipla Whatsapp Chat Line
(9am-4pm, 7 days a week)
076 882 2775
24 hour Healthcare Workers Care Network Helpline
0800 21 21 21
0800 515 515
EMERGENCY Contact Numbers for Students in South Africa - Click here
MENTAL HEALTH CALENDAR 2021
Teen Suicide Prevention Week
14 - 21 February
World Bipolar Day
SA Bipolar Awareness Day
Substance Abuse Awareness Day
Mental Health Awareness Month
1 – 31 July
Panic Awareness Day
World Suicide Prevention Day
World Mental Health Day
World Mental Awareness Month
1 - 31 October
View our list of informative Infographics.
SADAG KZN Branch
SADAG has an office in Durban with the support of Psychiatrist Dr Suvira Ramlall and Clinical Psychologist, Suntosh Pillay. Administrated by Lynn Norton
The KZN Branch is deeply committed to:
- Launching new Support Groups
- Workshops on Mental Health
- School Talks on Suicide Prevention
- Corporate Wellness For KZN companies
Want to become a volunteer counsellor? Contact Senzi 011 234 4837
Click here for more information.
If you are interested in starting a Support Group, please contact Krystle on 0800 21 22 23.
To find a Support Group in your area, please phone SADAG on 0800 21 22 23.
Click here for more information
Mental Health & Depression Book
A book called Surfacing, in which Marion Scher has sat down with a number of South Africans to share their stories of their personal struggles with mental health issues.
Want to know more? Click Here