Adherence and nonadherence to treatment for major depression

Major depressive disorder (MDD) is a mental health condition characterized by persistent low moods. A person with MDD may experience persistent sadness, hopelessness, loss of pleasure and enjoyment, anger, other negative emotions, and thoughts of suicide and/or self-harm. Problems with energy levels, sleep, appetite, concentration, and thinking are also common. These symptoms are severe enough to interfere with normal activities.

While the minimum duration of symptoms required for a diagnosis of MDD is two consecutive weeks, many people with MDD experience symptoms for longer periods of time, and often experience recurring episodes of symptoms.

In addition to MDD, there are other types of depression, and symptoms can vary depending on the type—though all types of depression feature persistent low moods, and all types require diagnosis and treatment.

Treatment for MDD

Treatment for major depressive disorder is typically a combination of antidepressant medications and psychotherapy. Antidepressants are medications that modulate moods and behaviors. These medications act on chemicals in the brain called neurotransmitters. There are many different types of antidepressant medications available, and different medications (and combinations of medications) work better for different people.

Psychotherapy is also known as “talk therapy,” and involves structured therapy sessions where a person will talk to a mental health professional. During these sessions, a person may work to improve awareness of a condition, understand how thoughts and behaviors affect moods, and build skills for coping and problem-solving. There are different types of psychotherapy that may be used in the treatment of depression, and a healthcare provider can explain what type they recommend and why.

A combination of medications and psychotherapy is typically more effective than using either approach on its own, but treatment does vary from person to person. Social support, lifestyle changes, and addressing coexisting health conditions can be other important elements of a treatment plan for depression.

Adherence to treatment

Following a treatment plan as prescribed by a healthcare provider will help a person get the best result from treatment. In medicine, following through with a prescribed treatment plan is referred to as adherence.

In the treatment of MDD, adherence means taking every dose of a medication on schedule. It also means attending appointments with a healthcare provider, including appointments for psychotherapy as well as appointments to monitor a person’s response to medications.

While taking a medication every day and attending appointments may seem like a simple enough routine to follow, it can be challenging for a variety of reasons. Many people who are being treated for depression miss doses of medication and/or miss appointments. Many people stop treatment without being instructed to by a healthcare provider.

Examples of potential reasons for medication non-adherence:

• Concerns about side effects from medication
• Forgetting to take a medication
• Complexity of having to take multiple medications
• Belief that the medication is not working or will not work
• Lack of clear instructions on how to take the medication
• Lack of information on how the medication works and how long it takes to work
• Side effects, or not liking how you feel while taking a medication
• Concerns about the cost of treatment

What to do if you need to improve adherence

Better adherence to treatment is associated with better treatment outcomes. Nonadherence to medications increases the risk of relapses/recurrences of major depressive episodes, more severe symptoms, emergency department visits, and hospitalizations.

Take some time to think about your experiences with treatment adherence. It can help to write this information down and bring it to an appointment to discuss with your healthcare providers.

Be honest about your experiences and start a conversation about ways to improve adherence. For example, if your work schedule makes it difficult to remember to take a medication on time, you might set an alarm on a phone or watch to remind you. If you are concerned about side effects, tell your healthcare provider, and ask how side effects can be managed.

Your healthcare provider will be your best source of information—but in order to provide you with the information and the care that you need, your healthcare provider needs to know about your experiences, your questions, and your concerns.