Reluctance to take antidepressants tied to misconceptions.
"Depression is highly prevalent but undertreated in elderly primary care patients, despite the availability of effective medications," Jane L. Givens, M.D., reported at the annual meeting of the Society of General Internal Medicine. Among the patient-level factors preventing appropriate treatment in this population are fear of addiction, concern about experiencing unnatural happiness or inability to feel grief and sadness, and fear of side effects.
Dr. Givens and her colleagues at the University of Pennsylvania in Philadelphia recruited a subsample of 68 older adults (mean age 75 years) with depression who participated in one of two qualitative, randomized treatment studies--the Prevention of Suicide in Primary Care Elderly: Collaborative Trial (PROSPECT) or the Primary Care Research in Substance Abuse and Mental Health for the Elderly (PRISM-E). Each of the patients participated in semistructured home-based interviews, which were audiotaped, transcribed, and entered into qualitative data analysis software.
The investigators used the coded transcripts to identify key features of the patient narratives concerning reluctance or refusal to consider drug therapy for depression. "Four themes emerged from this review," Dr. Givens said. "Many expressed a fear of needing to take antidepressants for the rest of their lives or of becoming addicted. Some did not want to be unnaturally happy or to mute their capacity to feel sadness or to 'face reality.'"
Other patients resisted treating symptoms of sadness associated with the loss of a loved one, and some had previous histories of treatment with psychiatric medications, including tranquilizers, and were concerned about the side effects, particularly sedation, Dr. Givens noted.
Many studies have linked depression to excess morbidity and mortality in elderly patients because of insufficient screening and detection and inadequate treatment. The findings of this study suggest that identifying depressed patients and offering them pharmacologic therapy may not be enough. "There is a need for more patient education and dialogue about the characteristics of current antidepressant therapy," taking specific care to correct lingering misconceptions, she concluded.
BY DIANA MAHONEY
New England Bureau
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|Publication:||Internal Medicine News|
|Date:||Jul 15, 2005|
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