Antidepressants in primary care: patients’ experiences, perceptions, self-efficacy beliefs, and nonadherence

Abstract

Hans Wouters,1 Marcel L Bouvy,1 Erica CG Van Geffen,1 Helga Gardarsdottir,1,2 Anne M Stiggelbout,3 Liset Van Dijk41Division of Pharmacoepidemiology and Clinical Pharmacology, Faculty of Science, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, 2Department of Clinical Pharmacy, Division Laboratory and Pharmacy, University Medical Center Utrecht, Utrecht, 3Department of Medical Decision Making, Leiden University Medical Center, Leiden, 4Netherlands Institute for Health Services Research (NIVEL), Utrecht, The NetherlandsPurpose: Patient adherence to antidepressants is poor. However, this is rather unsurprising, given the equivocal efficacy, side effects, and practical problems of antidepressants. The aim of this study was to examine a wide array of patient experiences and perceptions regarding the efficacy, side effects, and practical problems of antidepressants, as well as their associations with nonadherence, and whether patients’ perceived self-efficacy moderated these associations.Patients and methods: Experiences and perceptions of 225 patients, recruited through community pharmacies, were efficiently assessed with the Tailored Medicine Inventory. Nonadherence was assessed through self-report and pharmacy refill data.Results: Many patients were not convinced of the efficacy, thought the efficacy to be limited or did not believe antidepressants to prevent relapse, were worried about or had experienced one or more side effects, and/or had experienced one or more practical problems regarding information, intake, and packaging. Being convinced of efficacy was associated with lower intentional nonadherence (odds ratio [OR] 0.9, 95% confidence interval [CI] 0.8–0.96). A higher number of practical problems experienced was associated with increased unintentional nonadherence (OR 1.3, 95% CI 1.1–1.7). Higher perceived self-efficacy regarding taking antidepressants was associated with lower unintentional nonadherence (OR 0.7, 95% CI 0.5–0.9). Perceived self-efficacy did not moderate associations of patient experiences and perceptions with nonadherence.Conclusion: Assessing a wide array of patients’ experiences and perceptions regarding the efficacy, side effects, and practical problems of antidepressants contributes to better understanding of nonadherence to antidepressants. Guiding physician–patient conversations by patients' experiences and perceptions may reduce both unintentional and intentional nonadherence. Also, it may give rise to considerations of prudent discontinuation, eg, when patients are not convinced of the efficacy.Keywords: antidepressants, efficacy, side effects, practical problems, patients' experiences and perceptions, perceived self-efficacy, nonadherence