New Study Shows Gap in Patient/Physician Communication for Those with Major
A new survey (1/01) conducted by the National Depressive
and Manic-Depressive Association (National DMDA) shows that more than three
out of four people being treated for major depression feel their illness isn't
under complete control. Yet more than half of those who have had antidepressant
side effects stopped using their medication. Why? This survey identifies that
a significant communication gap between primary care physicians and patients
is at the root of the problem. As a result, the National DMDA wants health
care providers and patients to open new channels of communication to improve
recovery rates among the growing number of consumers who turn to primary care
physicians for treatment of depression.
Primary care physicians and patients alike need to become
more aware that depression can be just as disabling as any other chronic disease
and should be treated accordingly. Often, depressive illnesses are more complicated
to diagnose and treat because there is no blood test or objective marker to
monitor improvement. In fact, the only tool we have to monitor progress during
treatment is open and effective communication.
Findings from the survey, "Beyond Diagnosis: A Landmark Survey on Depression
and Treatment" report discrepancies between physicians and patients about
antidepressant therapy and its side effects: what side effects to expect, what
should be tolerated, how long they will last, and what can be done about them.
The survey involved interviews with 1,001 patients and nearly 900 primary care
physicians. Key findings include:
- Patients report that their depression is not under complete control
and they have experienced few specific quality-of-life improvements.
While the majority of patients say antidepressant therapy has had a positive
effect on their lives (85%), less than one in four feel their depression has
been completely controlled in the past two months, despite taking their current
medications for an average of three to five years. In addition, while
a substantial number of patients reported that before treatment, depression
had a negative effect on several aspects of their lives, including sleeping
(76%) and their sex life (59%), significantly fewer were able to identify
improvements in these areas after medical treatment. Only 13% reported improved
sleep and only 3% regained their sex drive.
- Doctors say they routinely alert patients about side effects when
prescribing antidepressants; patients say this is often not the case.
The gap is most prominent with sexual side effects and weight gain, issues
of particular concern to women. Physicians acknowledge that these two side
effects are very common, but patients rarely link them to their antidepressant.
To compound this problem, these two topics are particularly difficult for
people to discuss with physicians or anyone else. While 69% of physicians
say they usually mention sexual problems as a possible side effect and 47%
usually mention weight gain, significantly fewer patients say either of these
was ever mentioned (16% sexual problems; 16% weight gain).
- Patients believe they have to tolerate side effects unnecessarily
when other options exist. Few primary care physicians (27%) believe
that antidepressant side effects are temporary or can't be avoided (9%), compared
to a significant proportion of patients (59% and 40%, respectively) who believe
they have to put up with side effects in order to benefit. This raises questions
about how often patients withhold concerns or experiences with side effects
from physicians, and whether physicians consistently monitor the impact of
treatment side effects throughout the duration of therapy.
- Patients may feel discouraged about discussing side effect concerns
with physicians. While 90% of the patients who had side effects say
they told their primary care doctor about them, nearly 20% also report that
their doctor "did not do anything" in response. Specifically, 9% were told
it was "normal," 7% were told to "wait and see," and another 4% said their
doctor simply "did nothing". This scenario could be linked to patients' perceptions
that side effects must be tolerated -- if the doctor dismisses the patient's
concerns, patients may be reluctant to raise the topic again and assume they
have to put up with the side effect in order to get better.
- Side effects lead to serious forms of non-compliance. Almost
half of all patients surveyed (47%) report having had side effects, which
caused 55% to stop taking their antidepressant and 17% to skip doses. A significant
number of patients still report having side effects (15%), despite taking
their current antidepressant for an average of three years.
- Patients are not offered the chance to participate in treatment decisions.
While 71% of the physicians say treatment decisions are made jointly with
patients, only 54% of patients think this is the way treatment decisions occur.
Furthermore, only 36% of patients report that their primary care doctor asked
about their preferences or willingness to tolerate certain side effects before
making a decision about which antidepressant to prescribe.
National Depressive and Manic
Depressive Association Calls For Move Beyond Diagnosis
Many antidepressants are equally effective, but they
may not be equally effective for each patient. Furthermore, like all medicines,
all antidepressants have side effects -- but different patients may have different
experiences on different medications, even among the same family of drugs.
Different patients may also respond at different doses. There is no way to
anticipate which patients will respond best to which medicines at which doses.
All of these factors mean that doctors and patients need to work together to
find the best treatment for each individual's needs. There may be a few rounds
of "trial and error" before the best treatment plan is identified.
The National DMDA's "call to action" is one of the
first such initiatives to focus on improving the treatment and management of
depression beyond diagnosis and throughout the duration of therapy. Recognizing
that both consumers and physicians need to take joint responsibility to improve
outcomes in the treatment of depression, the National DMDA is developing professional
and patient educational activities and materials. In addition, eleven of the
nation's leading primary care and mental health organizations joined the National
DMDA in the planning phase of this initiative. They included: the American
College of Physicians-American Society of Internal Medicine, the American Medical
Association, the Society of General Internal Medicine, the Society of Teachers
of Family Medicine, the American Medical Women's Association, the Association
of Directors of Family Medicine, the American Psychiatric Association, the American
Psychiatric Nurses Association, the American Association for Marriage and Family
Therapy, the Illinois Academy of Family Physicians, and the MacArthur Initiative
on Depression & Primary Care at Dartmouth Medical School.
Founded in 1986, the National DMDA is the nation's largest patient-directed,
illness-specific organization with more than 400 support groups across the United
States and Canada. Its mission is to educate patients, family members, professionals
and the public that mood disorders are treatable medical illnesses.
information on women and depression from DrDonnica.com, click here.
Click here for more information about depression or other mental
For more information on National DMDA programs, click
Created: 2/14/2001  - Donnica Moore, M.D.