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New Study Shows Gap in Patient/Physician Communication for Those with Major Depression

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.

For more information on women and depression from DrDonnica.com, click here.

Click here for more information about depression or other mental health issues.

For more information on National DMDA programs, click here.

Created: 2/14/2001  -  Donnica Moore, M.D.

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