MS news articles for January 2001
and Patients Don't Talk About Antidepressant Side Effects
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
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,
Other key survey
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).
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.
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%).
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
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."
© 2001 by Medscape