Reasons for Antidepressant Nonadherence Among Veterans Treated in Primary Care Clinics
Abstract
OBJECTIVE: To examine the experiences of veterans (mostly middle-aged and elderly men) prescribed antidepressants, specifically with regard to different types of nonadherence, reasons for nonadherence, and side effects. METHOD: A mixed-methods analysis of Department of Veterans Affairs primary care patients (N = 395) with depression (9-item depression scale of the Patient Health Questionnaire criteria) enrolled in a randomized collaborative care trial was conducted. Adherence was measured from patient self-report and pharmacy data. Qualitative interviews elicited in-depth information regarding adherence. The study was conducted from April 2003 to September 2005. RESULTS: The intervention significantly improved self-reported adherence at 6 months (OR = 2.1; 95% CI, 1.0-4.4; P = .04) and 12 months (OR = 2.7; 95% CI, 1.4-5.4; P < .01), as well as medication possession at 12 months (OR = 1.82; 95% CI, 1.0-3.2; P = .04). The most common type of nonadherence at 6 months was discontinuation (12.2%), followed by not taking as prescribed (10.9%) and never took (4.8%). For patients discontinuing their antidepressant in the first 6 months, the most common and important reason was that it was not helping. Only 19.4% of patients with self-reported adherence ≥ 80% responded to treatment by 6 months. Side effects were also a commonly reported reason for discontinuation at 6 months, with 82% reporting experiencing side effects. One-third (31.4%) reported difficulty with sexual activity at 6 months, with 66.1% reporting that it was severe. Qualitative interviews supported the finding that side effects, and generally not feeling like oneself, are important adherence barriers. CONCLUSIONS: In this sample of mostly middle-aged and elderly men with depression, treatment nonresponse and side effects were the rule rather than the exception. These findings suggest that nonadherence may have resulted primarily from patients' negative experiences with antidepressants rather than structural barriers or noncompliant behaviors. TRIAL REGISTRATION: Clinicaltrials.gov Identifier: NCT00105690.
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Tolerability and side effects are closely related because side effects from antidepressants are some of the most common factors responsible for treatment discontinuation.
“Although tolerability might be considered different from side effects, the two could also be closely related because side effects from antidepressants are some of the most common factors responsible for the treatment discontinuation.7”
From Addressing the Side Effects of Contemporary Antidepressant Drugs: A Comprehensive Review (2018) · cites this paper as [7]
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“Health beliefs [31,35,43] Attitudes concerning depression [49] Understanding of depression [50–53] Understanding the persistence of depression [54] Understanding postnatal depression [55] Conceptualization of depression [56] Illness model [57,58] A faith-based model of depression [59] Problem…”
- Authors
- Fortney, J. C., Pyne, J. M., Edlund, M. J., Stecker, T., Mittal, D., Robinson, D. E., & Henderson, K. L.
- Affiliations
- Health Services Research & Development (US)
- University of Arkansas for Medical Sciences (US)
- Louisiana State University Health Sciences Center Shreveport (US)
- South Central VA Health Care Network (US)
- Corresponding author
- Fortney, John C.
- Venue
- The Journal of Clinical Psychiatry
- Publisher
- Physicians Postgraduate Press, Inc
- Published
- 2010-11-16
- Volume
- 72
- Issue
- 06
- Pages
- 827-834
- ISSN
- 0160-6689 (ISSN-L)
- OpenAlex
- W1980058842
- Cited by
- 80
- References
- 0
- Citations by year
- 2026: 3 · 2025: 5 · 2024: 3 · 2023: 8 · 2022: 4 · 2021: 8 · 2020: 6 · 2019: 6 · 2018: 4 · 2017: 5 · 2016: 5 · 2015: 4 · 2014: 4 · 2013: 6 · 2012: 5
- FWCI
- 4.40
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The Journal of Clinical Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Family Practice › Medication Adherence and Compliance
- Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
- Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
- Keywords
- veterans, depression, adverse drug reactions, sexual dysfunction, treatment discontinuation, collaborative care, primary care, treatment response, older men
- MeSH terms
- Antidepressive Agents, Depressive Disorder, Female, Humans, Male, Middle Aged, Psychiatric Status Rating Scales, Regression Analysis, Risk Factors, Time Factors, United States, Veterans, Medication Adherence
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