Nearly half of patients with depression drop out of treatment in a public clinic within 12 months
More than 20 million people in the United States suffer from depression, and about 3 out of 10 people get better with the first antidepressant they try. However, a new study finds that nearly half the 179 patients receiving guideline-based treatment for depression in 4 Texas public health clinics discontinued treatment within 12 months. Diane Warden, Ph.D., M.B.A., of the University of Texas Southwestern Medical Center, and colleagues studied data on adult patients who were diagnosed with major depressive disorder (MDD) to determine dropout predictors. Patients who had fewer few side effects at baseline and younger patients tended to drop out more often in the first 6 months of treatment. In fact, the likelihood of abandoning treatment decreased 26 percent with every 5-year increase in age. At the 12-month mark, dropout predictors included younger age, negative attitudes about psychiatric medications, and higher perceived physical functioning. Additionally, making more frequent monthly visits to the clinic was associated with higher dropout rates.
Frequent visits may be necessary to ensure patients are receiving the correct dose of antidepressants, to monitor side effects, which are common with antidepressants, and to change the antidepressant treatment approach if it is not working. However, numerous visits may pose a burden to patients. More frequent visits may also have meant that a patient was not getting better or suffering side effects-reasons that patients sometimes leave treatment. These predictors point to a need for a personalized approach to treating patients with MDD, the authors suggest. All patients can benefit from basic education about depression. Discussing beliefs and attitudes about antidepressant medications with patients also allows clinicians to address any fears or misperceptions, which may help keep patients in treatment. This study was funded in part by the Agency for Healthcare Research and Quality (HS17189). See “Predictors of attrition during one year of depression treatment: A roadmap to personalized intervention,” by Dr. Warden, A. John Rush, M.D., Thomas J. Carmody, Ph.D., and others in the March 2009 Journal of Psychiatric Practice 15(2), pp. 113-124.
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