Nonacceptance of Selective Serotonin-Reuptake Inhibitor Treatment
Nonacceptance of Selective Serotonin-Reuptake Inhibitor Treatment
Background: Studies have shown that up to 38% of patients who start treatment with antidepressants fill only a single prescription at the pharmacy, apparently not accepting treatment.
Objective: To determine characteristics and reasons associated with nonacceptance of selective serotonin-reuptake inhibitor (SSRI) treatment.
Methods: A retrospective study was conducted in 37 community pharmacies in the Netherlands; patients who presented a prescription from a general practitioner (GP) for a newly started SSRI treatment were selected. Nonaccepters were defined as patients who filled only one SSRI prescription; patients who received at least 3 fills of an SSRI prescription were defined as accepters. Patient characteristics were obtained from automated dispensing records and from questionnaires. Areas of evaluation included sociodemographics, disease, and treatment. Nonaccepters were asked their reasons for not filling second prescriptions.
Results: Of the patients who started SSRI treatment, 22.0% were nonaccepters, filling only a single prescription. Fifty-seven nonaccepters and 128 accepters were included in our analysis. Nonacceptance was more common among patients with a low level of education (OR 2.6; 95% CI 1.1 to 5.9) and in patients who reported nonspecific symptoms like fatigue, stress, and restlessness as the reason for SSRI use (OR 2.7; 95% CI 1.4 to 5.5). Of the nonaccepters, 29.8% (n = 17) did not start SSRI use, and 70.2% (n = 40) discontinued SSRI use within 2 weeks. Fear of adverse effects and the actual occurrence of adverse effects were main reasons for not accepting SSRI treatment. Of the nonaccepters, 55.0% discontinued treatment without informing their GPs.
Conclusions: Acceptance of SSRI treatment is a decisive moment in a patient's adherence to treatment initiated by his or her GP and deserves more attention; GPs and pharmacists should address treatment issues, especially in groups at risk for nonacceptance.
Guidelines recommend that treatment with antidepressants be continued for at least 6 months after remission of depression or anxiety-related symptoms. Since the introduction of selective serotonin-reuptake inhibitors (SSRIs), the vast majority of patients who receive antidepressant treatment start with SSRIs, which are predominantly prescribed by general practitioners (GPs). Studies show that up to 38% of patients who start treatment with antidepressants fill only a single prescription at the pharmacy. Thus, many patients discontinue treatment long before the recommended minimum duration.
Patients who start SSRI treatment may need to overcome several hurdles. Receiving a first prescription for antidepressant medication is often considered a distressing event. During this initial consultation, patients who are depressed may experience difficulty absorbing the information given. Also, following initiation of SSRI treatment, adverse effects may occur before any therapeutic effect is perceived.
The course of drug use has been described as consisting of 3 parts: acceptance of the treatment plan leading to initiation, execution of the drug regimen, and eventual discontinuation. Studies on nonadherence seldom clearly distinguish between these phases. Specific studies on patients who have declined treatment are scarce; as a consequence, the acceptance phase of drug treatment has received little attention. The objective of our study was to determine whether sociodemographic, disease, or treatment characteristics are associated with nonacceptance of SSRI treatment and describe the reasons that patients fill only a single prescription of an SSRI at the pharmacy.
Background: Studies have shown that up to 38% of patients who start treatment with antidepressants fill only a single prescription at the pharmacy, apparently not accepting treatment.
Objective: To determine characteristics and reasons associated with nonacceptance of selective serotonin-reuptake inhibitor (SSRI) treatment.
Methods: A retrospective study was conducted in 37 community pharmacies in the Netherlands; patients who presented a prescription from a general practitioner (GP) for a newly started SSRI treatment were selected. Nonaccepters were defined as patients who filled only one SSRI prescription; patients who received at least 3 fills of an SSRI prescription were defined as accepters. Patient characteristics were obtained from automated dispensing records and from questionnaires. Areas of evaluation included sociodemographics, disease, and treatment. Nonaccepters were asked their reasons for not filling second prescriptions.
Results: Of the patients who started SSRI treatment, 22.0% were nonaccepters, filling only a single prescription. Fifty-seven nonaccepters and 128 accepters were included in our analysis. Nonacceptance was more common among patients with a low level of education (OR 2.6; 95% CI 1.1 to 5.9) and in patients who reported nonspecific symptoms like fatigue, stress, and restlessness as the reason for SSRI use (OR 2.7; 95% CI 1.4 to 5.5). Of the nonaccepters, 29.8% (n = 17) did not start SSRI use, and 70.2% (n = 40) discontinued SSRI use within 2 weeks. Fear of adverse effects and the actual occurrence of adverse effects were main reasons for not accepting SSRI treatment. Of the nonaccepters, 55.0% discontinued treatment without informing their GPs.
Conclusions: Acceptance of SSRI treatment is a decisive moment in a patient's adherence to treatment initiated by his or her GP and deserves more attention; GPs and pharmacists should address treatment issues, especially in groups at risk for nonacceptance.
Guidelines recommend that treatment with antidepressants be continued for at least 6 months after remission of depression or anxiety-related symptoms. Since the introduction of selective serotonin-reuptake inhibitors (SSRIs), the vast majority of patients who receive antidepressant treatment start with SSRIs, which are predominantly prescribed by general practitioners (GPs). Studies show that up to 38% of patients who start treatment with antidepressants fill only a single prescription at the pharmacy. Thus, many patients discontinue treatment long before the recommended minimum duration.
Patients who start SSRI treatment may need to overcome several hurdles. Receiving a first prescription for antidepressant medication is often considered a distressing event. During this initial consultation, patients who are depressed may experience difficulty absorbing the information given. Also, following initiation of SSRI treatment, adverse effects may occur before any therapeutic effect is perceived.
The course of drug use has been described as consisting of 3 parts: acceptance of the treatment plan leading to initiation, execution of the drug regimen, and eventual discontinuation. Studies on nonadherence seldom clearly distinguish between these phases. Specific studies on patients who have declined treatment are scarce; as a consequence, the acceptance phase of drug treatment has received little attention. The objective of our study was to determine whether sociodemographic, disease, or treatment characteristics are associated with nonacceptance of SSRI treatment and describe the reasons that patients fill only a single prescription of an SSRI at the pharmacy.
