Approaches to the enhancement of patient adherence to antidepressant medication treatment.

The number of safe and effective medication treatments for depression has increased significantly over the past 10 years. Relative to the older tricyclic antidepressants and monoamine oxidase inhibitors, the newer medications offer comparable efficacy with fewer side effects and a markedly reduced risk for serious adverse effects. In spite of these benefits, and in spite of the extensive and successful efforts that have been made to inform the general population about the diagnosis and treatment of depression, many patients do not comply with treatment recommendations. Although specific factors such as side effects lead to high rates of noncompliance with medication treatment, noncompliance is a multifactorial phenomenon. The reasons for noncompliance can include rational and intentional decisions based on beliefs about the illness, concerns over side effects, ineffectiveness of treatment. costs of the medication, decisions influenced by the symptoms of the disorder, and many other cultural and attitudinal factors. Some of the important concepts that should be addressed with depressed patients are reviewed. Strategies aimed at informing patients about depression and its treatment and providing a collaborative treatment environment have the potential to significantly improve treatment outcome and treatment adherence.