The True Cost of Noncompliance in Antidepressant Therapy

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Introduction

Depression is among the most common psychiatric disorders in the United States, with lifetime prevalence rates in excess of 17%.^[1] It is not surprising, then, that depression places a substantial economic burden on the US healthcare system, and current costs exceed $81 billion per year.^[1] Worldwide, the economic toll of depression is far greater. By the year 2020, the World Health Organization projects depression to be the second leading cause of global disease burden.^[1]

One of the best ways for clinicians to reduce this staggering disease burden is to simply treat depressed patients correctly, for a long enough period of time. Data support the findings that antidepressant responders who remain on their antidepressants for up to 36 months have relapse rates of only 18%, whereas those who are switched to placebo have relapse rates that exceed 40%.^[2] Indeed, long-term antidepressant treatment works, but, unfortunately, patients often don't "sign up" for such long-term approaches.

Compliance with antidepressant treatment is abysmally low. In 1995, Lin and colleagues^[3] demonstrated that 28% of patients discontinued their antidepressants within the first month, often before the drug had much chance to work. Given that over half of the patients Lin followed were on tricyclic antidepressants (TCAs), one would now anticipate that since prescribing patterns have shifted to better-tolerated antidepressants (selective serotonin reuptake inhibitors [SSRIs], bupropion, etc.), compliance would have improved over the last few years. However, that doesn't seem to be the case.

In recently analyzed adherence data from over 740,000 newly initiated immediate-release SSRI patients, Eaddy and associates^[4] found that nearly 50% of patients failed to adhere to therapy for a minimum of 60 days, and only 28% were compliant at 6 months.

Why do patients prematurely discontinue antidepressants, medications that may improve and perhaps even save their lives? The reasons vary but typically distill down to one of the 3 Cs of noncompliance: confusion, costs, and complaints. Let's take a closer look at these critical factors.