More MS news articles for January 2001

Doctors and Patients Don't Talk About Antidepressant Side Effects

http://healthwatch.medscape.com/medscape/p/gcommunity/HNews/hnews.asp?RecID=232387

By Carla Cantor

Jan. 22 (CBS HealthWatch)--A new public health survey reveals that nearly half of the people being treated with antidepressants experience side effects and 55% of those patients stop taking their medication, rather than talk to their doctors about the issue.

The root of the problem? A significant communication gap between primary care physicians and patients, says a report on the survey, commissioned by the National Depression and Manic Depression Association (National DMDA). When it comes to talking about treatment and side effects-- what to expect, what should be tolerated, and what can be done--the report shows the physician-patient relationship seems to break down.

"The survey reveals serious disconnect between primary care doctors and patients," says James Pradko, MD, a family practitioner in New Baltimore, Michigan, who conducts research on antidepressants and sexual dysfunction.

"It's not that the doctors aren't aware or don't care about side effects, " Pradko says. "They are afraid that if they talk about them, depressed patients--who tend to resist the diagnosis and treatment--will go off their medication," he explains. "The doctor is thinking, 'If only I can get the patients to stay on the antidepressant for nine months.' [when they are less likely to relapse]. But that kind of reasoning backfires."

The survey, one of the largest national surveys on attitudes toward and experience with depression and its treatment, involved interviews with 1,001 patients and nearly 900 primary care physicians. On average, patients had been first prescribed an antidepressant 11 years earlier and had been taking their current antidepressant for three to five years. Yet after years of therapy, 15% still reported problems with side effects. Among all patients surveyed, 47% reported side effects, which caused 55% of them to stop taking their antidepressant and 17% to skip doses. The most common side effects: weight gain, sexual dysfunction, and drowsiness.

Other key survey findings:

Patients say their depression is not under complete control. Although the majority of patients say antidepressant therapy has had a positive effect on their lives (85%), less than a quarter feel their depression is completely under control. In addition, while many patients report that before treatment depression had a negative effect on their lives, including sleep (76%), and sex life (59%), significantly fewer were able to identify improvements in these areas as a result of treatment (13% slept better; 3% regained their sex drive).

Patients believe they have to tolerate side effects--even though there are other options, such as switching medication. Few primary care physicians believe that antidepressant side effects cannot be avoided (9%), compared to a significant proportion of patients (40%) who assume they have to put up with side effects. This raises questions about how often patients withhold concerns or experiences with side effects from physicians, and whether physicians consistently monitor the impact of side effects throughout therapy, according to the report.

Physicians and patients express different perceptions about treatment decisions and side effects. Primary care physicians say they routinely alert patients about side effects, but just 36% of patients say their doctor asked about their preferences or willingness to tolerate certain side effects before deciding which antidepressant to prescribe. And while 90% of the patients who had side effects say they told their doctors about them, close to 20% claim that their doctor did little or anything in response. (Specifically, 9% were told side effects were "normal," 7% were told to "wait and see," and 4% said their doctor simply did nothing.) Similarly, three-quarters of physicians surveyed say treatment decisions are made jointly with patients, but only 54% of patients agree.

As a result of such findings, the National DMDA has urged the primary care community to move beyond diagnosis to improvements in managing depression. Lydia Lewis, executive director of the National DMDA, says that new channels of communication must be opened to improve the chances for recovery among the growing number of people who turn to primary care physicians for treatment. The majority of patients (64%) in the survey were initially diagnosed by a primary care doctor and most depend on that doctor exclusively for treatment (84%).

"Successful treatment of depression should be based on both symptom relief and freedom from side effects," Lewis says "This can best be achieved when physicians and patients talk more fully and openly throughout the course of treatment and make adjustments in antidepressant treatment tailored to each patient's needs."