Patient Prefer Adherence. 2016 Jul 28;10:1401-7. doi: 10.2147/PPA.S110632. eCollection 2016.
Long-term antidepressant use: patient perspectives of benefits and adverse effects.
Cartwright C1, Gibson K1, Read J2, Cowan O1, Dehar T1.
Abstract and free full text at http://www.ncbi.nlm....pubmed/27528803
Long-term antidepressant treatment has increased and there is evidence of adverse effects; however, little is known about patients' experiences and views of this form of treatment. This study used mixed methods to examine patients' views and experiences of long-term antidepressant treatment, including benefits and concerns. Data from 180 patients, who were long-term users of antidepressants (3-15 years), were extracted from an anonymous online survey of patients' experiences of antidepressants in New Zealand. Participants had completed rating scales about the effectiveness of antidepressants, levels of depression before and during antidepressant use, quality of life, and perceived adverse effects. Two open-ended questions allowed participants to comment on personal experiences. The majority (89.4%) reported that antidepressants had improved their depression although 30% reported moderate-to-severe depression on antidepressants. Common adverse effects included withdrawal effects (73.5%), sexual problems (71.8%), and weight gain (65.3%). Adverse emotional effects, such as feeling emotionally numb (64.5%) and addicted (43%), were also common. While the majority of patients were pleased with the benefits of antidepressant treatment, many were concerned about these adverse effects. Some expressed a need for more information about long-term risks and increased information and support to discontinue.
From the full text:
The majority of patients in this study believed that antidepressants alleviated their depression and improved their quality of life to some degree, although 30% reported moderate-to-severe depression while using antidepressants. As reported in 2013, experiences of adverse effects were common.12 However, Bet et al’s study12 did not examine the adverse emotional effects reported in this study nor did it examine the patients’ reports of withdrawal symptoms.
Some patients in this study were particularly concerned about severe withdrawal symptoms that undermined their confidence to discontinue should they wish to and therefore limited their choices. In line with this, 45% patients also believed that they had some level of addiction to the antidepressant. Some patients were also critical of the lack of information given by prescribers with regard to adverse effects, including withdrawal symptoms. Some also expressed disappointment or frustration with the perceived lack of support available to them in managing withdrawal.
A previous study of patients’ beliefs regarding adherence to antidepressant maintenance treatment (75 weeks) found that adherence was highest when the perceived need exceeded concerns about safety and lowest when concerns exceeded perceived need.20 In this study, some patients reported adhering to treatment because of safety concerns linked to withdrawal symptoms rather than a perceived need for the antidepressant per se. Finally, approximately 25% participants wrote about the alternative activities and treatments that they believed could aid recovery. One in six wrote about their perceptions of the importance of therapy or counseling either as an alternative to, or in combination with, antidepressant medication.